Workers' Compensation Glossary · Insurance

D-ratio (discount ratio): the share of a class's expected losses expected to be primary, used to split expected losses in the experience mod (Rating Workers' Comp & Premium Audit).
EDI Claims (IAIABC): the standard for electronic first and subsequent reports of injury from insurers to state agencies, now Release 3.1 (Workers' Comp Claims).
Employers liability: Part Two of the workers' compensation policy, covering employee injury suits outside the exclusive remedy, with stated limits (Workers' Compensation).
Experience modification (mod): a bureau-computed factor comparing an employer's actual losses to expected losses for its classes and payroll, applied to manual premium (Rating Workers' Comp & Premium Audit).
First Report of Injury (FROI): the EDI transaction reporting a workers' compensation claim and its facts to the state (Workers' Comp Claims).
Large deductible plan: a standard workers' compensation policy under which the employer reimburses the insurer for each claim up to a deductible, secured by collateral (Rating Workers' Comp & Premium Audit).
Medicare set-aside (WCMSA): money allocated in a settlement for future Medicare-covered care, reviewed by CMS above set thresholds (Workers' Comp Claims).
Monopolistic state fund: a state fund that is the only source of primary workers' compensation insurance in its state (North Dakota, Ohio, Washington, Wyoming) (Workers' Compensation).
Multiple coordinated policy: a PEO workers' compensation structure with a separate policy for each client, so each keeps its own experience (Workers' Compensation).
Non-subscriber: a Texas employer that has elected not to carry workers' compensation and so loses its common law defenses (Workers' Compensation).
Pay-as-you-go: workers' compensation premium computed and paid from each payroll run rather than an annual estimate (Rating Workers' Comp & Premium Audit).
Premium audit: the post-term review of actual payroll by class and state that replaces the estimate and sets the final premium (Rating Workers' Comp & Premium Audit).
Primary and excess losses: the parts of each claim below and above the experience rating split point, weighted fully and partly in the mod (Rating Workers' Comp & Premium Audit).
Retrospective rating: a plan that recomputes a policy year's premium from that year's own losses, within a minimum and maximum (Rating Workers' Comp & Premium Audit).
Section 111 reporting: the duty of workers' compensation insurers and self-insurers to report claims involving Medicare beneficiaries to CMS (Workers' Comp Claims).
Split point: the per-claim amount dividing primary from excess losses in the experience mod, now state-specific (for example $25,000 in North Carolina) (Rating Workers' Comp & Premium Audit).
Statutory coverage: Part One of the workers' compensation policy, which pays whatever benefits each listed state's law requires (Workers' Compensation).
Subsequent Report of Injury (SROI): an EDI transaction reporting a benefit event on a claim (initial payment, change, suspension, final) to the state (Workers' Comp Claims).
Waiting period: the first days of disability for which no indemnity is paid, refunded once disability lasts past a state's retroactive period (Workers' Comp Claims).