General terms Flashcards
To learn general terms
A formal request from an insurance company for coverage or compensation for a covered loss or policy event.
Claim
Any injury or damage that the insured suffers because of a covered accident or misfortune.
Loss
A person or organization covered by insurance.
Insured
Company that holds the insurance policy. In addition, it is the company to which insurance payments are sent and the company that pays if a covered claim is filed.
Carrier
Process of evaluating risk of insuring someone or something, to determine if it’s profitable for the insurance company to accept the risks.
Underwriting
Trained insurance professionals with specialized knowledge in risk assessment & determines whether they will insure something or someone and at what cost.
Underwriters
Individual or company authorized to represent an insured in the purchase, servicing & maintaining insurance coverage with a designated insurer.
Agent of record
Amount to be paid for an insurance policy.
Premium
State of being legally responsible for something.
Liability
A written law passed by a legislative body.
Statute
The substitution of one person or group by another in respect of a debt or insurance claim, accompanied by the transfer of any associated rights and duties.
Subornation
State of being at risk to a loss or claim.
Exposure
Total amount paid to employee for work performed.
Remuneration
aka payroll
4 digit number used to classify a specific job definition to help identify different workplace exposures.
Class Code
When an employee works more than 40 hours. Additional hours are paid at a time and a half rate
Overtime
Total amount paid to an employee before any taxes, deductions, premiums etc.
Gross Wage
Losses paid to claimant during the reported period
Paid loses
Losses reported to the insurer, but are still in settlement
Outstanding losses
Paid losses + outstanding losses
Incurred losses
Class of CW where injured employee is incapable of ever working anywhere. Will receive weekly wages
Permanent disability
Works on a person’s mental/physical work performance capacity.
Vocational Rehab
Cost of operating the ins business exclusive of losses or claims
Expense
Amount paid by carrier
Recovery
An employee’s pre-injury earning capacity preceding a work related injury.
Average Weekly Wage
The covered person making a claim or responsible for a loss
Claimant
The injured employee has hired an attorney to represent their interests on the worker’s comp claim
Litigated
A claim that has not been settled and/or payments are still being made
Open claim
A claim that has been settled.
Closed claim
The start date of an ins. policy
Inception date
The end date of an ins. policy
Expiration date
A statute for a claim where it was necessary for an injured employee to recuperate away from work
Disability
A status for a claim where an injured employee required medical treatment but did not have to miss any work time.
Non-disability
Payments made for an employee’s lost wages or a claim.
Paid compensation
Payment made for the medical treatment of an injured employee.
Paid Medical
Classification code that best describes the WC exposure of an employer’s business, determined by majority of payroll.
Governing Class Code
The cutoff date for adjustments made to paid claims and reserve estimates in a loss runs report
Valuation Date
An insured’s reported claims history for a specific policy period.
Loss Run Report
A unique identifier that attaches an insurance claim/ loss to a specific worker
Claim Number
The ultimate rate per class code after all debits and credits have been applied.
Net Rate
A contractual provision where one party agrees to waive its right to pursue another party in the case of a loss.
Waiver of Subrogation
A rating factor used to compare an insured’d claim and payroll history against other employers with similar operations.
Experience Modifier
A rate the insurance carrier has filed with the state for a class code that is starting point for premium calculations.
Base Rate
Manual Premium
= class code base rate X remuneration/100
Credit or debits an insurer may offer depending on the safety practices and claims history of an insured.
Scheduled Rating (aka rating plan)
A percentage discount dependent on the insured’s Total Standard Premium. Only policies which have exceeded state-standard minimum levels are eligible.
Premium Discount
A policy admin fee to cover the costs incurred by the ins co
Expense Constant
Terrorism
= remuneration / 100 X state terrorism factor
Additional charges for the policy as mandated by the state.
Assessment (aka ‘state’ or ‘mandatory surcharge’)
The payment plan assigned to the insured for the policy term.
Payroll Reporting
Estimated Modified Premium
= estimated manual premium X experience modification rating
The smallest acceptable premium acceptable premium for which an ins co will write a policy.
Minimum Premium
The rate after all credits and debits without factoring in the experience modifier.
Interim Billing Rate
An amendment to an insurance policy which adds, modifies, or eliminates coverage
Endorsement
A land motor vehicle, trailer or semi-trailer designed for travel on public roads.
Auto
A sudden, continuous or repeated exposure to the same conditions that results in “bodily injury” or “property damage”.
Accident
The insured or 3rd party making the claim or responsible for a loss.
Claimant
The amount paid to claimant for losses during the policy period.
Loss Paid
The amount paid for medical payments to claimant during the policy period.
Med Paid
The amount paid to claimant for insurance carrier-related expenses incurred during the policy period.
EXP Paid
The amount recovered by the insurance carrier from the at-fault party’s insurance carrier for expenses.
Expense Recovery
Short for deductible Recovery,’ it is the amount recovered by the insurance carrier from their insured’s deductible payment.
Deduct Recovery
The damaged property’s salvage value deducted from the claim.
Salvage Recovery
‘Subrogation Recovery”, it’s the amount the insured’s insurance carrier recovers from the at-fault party’s insurance carrier through subrogation.
Subro recovery
