# Workers' Compensation Glossary

> 19 terms from the Insurance book's Workers' Compensation part, each defined in a line and linked to the chapter that explains it.

- **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](https://www.syntaqx.com/books/insurance/rating-workers-comp#the-experience-mod)).
- **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](https://www.syntaqx.com/books/insurance/workers-comp-claims#edi-reporting-to-the-state)).
- **Employers liability:** Part Two of the workers' compensation policy, covering employee injury suits outside the exclusive remedy, with stated limits ([Workers' Compensation](https://www.syntaqx.com/books/insurance/workers-compensation#the-policy)).
- **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](https://www.syntaqx.com/books/insurance/rating-workers-comp#the-experience-mod)).
- **First Report of Injury (FROI):** the EDI transaction reporting a workers' compensation claim and its facts to the state ([Workers' Comp Claims](https://www.syntaqx.com/books/insurance/workers-comp-claims#edi-reporting-to-the-state)).
- **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](https://www.syntaqx.com/books/insurance/rating-workers-comp#retrospective-rating-and-deductible-plans)).
- **Medicare set-aside (WCMSA):** money allocated in a settlement for future Medicare-covered care, reviewed by CMS above set thresholds ([Workers' Comp Claims](https://www.syntaqx.com/books/insurance/workers-comp-claims#medicare-secondary-payer)).
- **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](https://www.syntaqx.com/books/insurance/workers-compensation#state-funds)).
- **Multiple coordinated policy:** a PEO workers' compensation structure with a separate policy for each client, so each keeps its own experience ([Workers' Compensation](https://www.syntaqx.com/books/insurance/workers-compensation#peos-and-master-policies)).
- **Non-subscriber:** a Texas employer that has elected not to carry workers' compensation and so loses its common law defenses ([Workers' Compensation](https://www.syntaqx.com/books/insurance/workers-compensation#texas-non-subscription)).
- **Pay-as-you-go:** workers' compensation premium computed and paid from each payroll run rather than an annual estimate ([Rating Workers' Comp & Premium Audit](https://www.syntaqx.com/books/insurance/rating-workers-comp#pay-as-you-go)).
- **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](https://www.syntaqx.com/books/insurance/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](https://www.syntaqx.com/books/insurance/rating-workers-comp#the-experience-mod)).
- **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](https://www.syntaqx.com/books/insurance/rating-workers-comp#retrospective-rating-and-deductible-plans)).
- **Section 111 reporting:** the duty of workers' compensation insurers and self-insurers to report claims involving Medicare beneficiaries to CMS ([Workers' Comp Claims](https://www.syntaqx.com/books/insurance/workers-comp-claims#medicare-secondary-payer)).
- **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](https://www.syntaqx.com/books/insurance/rating-workers-comp#the-experience-mod)).
- **Statutory coverage:** Part One of the workers' compensation policy, which pays whatever benefits each listed state's law requires ([Workers' Compensation](https://www.syntaqx.com/books/insurance/workers-compensation#the-policy)).
- **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](https://www.syntaqx.com/books/insurance/workers-comp-claims#edi-reporting-to-the-state)).
- **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](https://www.syntaqx.com/books/insurance/workers-comp-claims#indemnity-benefits)).

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