Definition

WCRI – Accountable Care Organizations (ACO’s) – Live

Accountable Care Organizations (ACO) The accountable care organizations (ACO)  are healthcare organizations characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Presenter Partners Healthcare Network – Dr. Chaqutunu There are 18.2 million lives that are covered

What is A Workers Comp Wage Statement – critical part of claim

Term Of The Day – Wage Statement A wage statement is a necessary yet tedious part of paying a WC claim properly.  The injured employee’s compensation rate is based on this integral part of processing a WC claim.  It is usually filed by the employer. Each state has its own special

What Is The Minimum Compensation Rate – Why Is It Important

Term Of The Day – Minimum Compensation Rate Most states have a minimum threshold of Workers Comp benefits regardless of their wage rate. If the injured employee’s Workers Compensation rate falls below this figure, it is increased to the minimum. For instance, if an employee earns $ 8 per hour and

What Is A Manuscript Policy?

Term Of The Day – Manuscript Policy A Manuscript Policy is an individually designed policy. It is negotiated by the insurer and the insured and is specific to the insured. The drafted terms and conditions of the policy are tailored to the needs of the insured.   ©J&L Risk Management Inc

Is the Average Value Method Good Claims Estimation?

Term Of The Day – Average Value Method Average Value Method has a requirement for estimates of loss reserves that are made on an aggregate basis for a group or even a category of claims. Typically, this method is used to set a temporary average value. An individual case estimate can be

Administrative Law Judge (ALJ) Hears Workers Comp Cases

Term Of The Day – Administrative Law Judge An Administrative Law Judge is a legal representative employed by the Workers’ Compensation Board. This representative reviews appealed administrative orders, holds impartial hearings, and issues legal opinions. Formerly called a hearings referee.   ©J&L Risk Management Inc Copyright Notice

Maximum Medical Improvement (MMI) – Doctor Says

Term Of The Day – Maximum Medical Improvement In most cases, Maximum Medical Improvement (MMI) is assigned by a treating physician when an injured employee’s condition has stabilized to the point that no major change is expected in his medical condition, despite continuing medical treatment. After MMI is assigned, the payment

Should We Hold Benefit Review Conference (BRC)?

Term Of The Day – Benefit Review Conference Various states offer Benefit Review Conference in order to help resolve issues and disputes resulting from on-the-job injuries. BRCs vary by state but typically involve an informal mediation conference administered by a neutral hearing officer or ombudsman. If a dispute is resolved at

Declaration Of Readiness To Proceed

Declaration Of Readiness To Proceed -California Work Comp Form The Declaration Of Readiness to Proceed resolves disputes in California.  Another of the forms required in California. It is a form used to request a hearing before a workers’ compensation judge when an injured employee is ready to resolve a dispute.

Application For Adjudication Of Claim

Term Of The Day – Application For Adjudication Of Claim  The Application for Adjudication Of Claim is the primary Workers Comp appeal form in California.  This term of the day is one from the WCAB in California. It is a form an injured employee files to open a case at the

What Is The Residual Market For Workers Comp?

Residual Market – Critical Under The Radar Coverage In insurance industry they need residual market for Workers Comp.Companies or industries that are considered high risk (for instance with an E-Mod of 1.7 and above) may not be able to obtain Workers Compensation insurance through the regular voluntary markets. The chart

What Is Assumption Of Risk Doctrine?

Term Of The Day – Assumption Of Risk The Assumption of Risk term creates a lessening of liability in certain situations..  Workers Compensation usually does not allow any defendants to use this type of defense due to the “no-fault ” provisions built into the Workers Compensation system Some states do

Plain Language Laws In Workers Comp and Other Policies

Plain Language Laws Is a Misnomer Term The Plain language laws have failed at making insurance policies readable.Many insureds, including Workers Comp, complain vehemently that insurance policies are almost impossible to read. Some states have laws that require insurance policies to be written in layperson’s terms. As most, if not

Is Vocational Rehabilitation Good For Claim?

Term Of The Day – Vocational Rehabilitation Vocational rehabilitation can include a plethora of services that are offered to injured employees to help them return to work following a work injury. VR may involve transferable skills assessments, educational courses, job search assistance, and many other vocational aids. Vocational rehabilitation is sometimes

How Much Is Ultimate Loss For Claim?

Term Of The Day – Ultimate Loss The ultimate loss contains two basic definitions. In reinsurance, the unit of loss to which the reinsurance applies, as determined by the reinsurance agreement. In other words, the gross loss. In liability insurance, the amount actually paid or payable for the settlement of a

Aggregate Excess Insurance

Term Of The Day – Aggregate Excess Insurance This type of insurance is critical for Workers Comp self insureds. Even if a self insured has no large claims, a substantial number of claims can be devastating to their insurance budget. Aggregate Excess Insurance places a limit on the amount an employer

Is Cumulative Trauma An Injury in Workers Compensation?

Term Of The Day – Cumulative Trauma An injury diagnosed by a physician as occurring without bodily injury being the direct cause of loss. Cumulative Trauma includes injury caused by continual stress and strain. Such injury may be casually related to a person’s job and may be due to repetitive traumatic

What Is Utilization Management Process?

Term Of The Day – Utilization Management The Utilization Management on a workers comp claim tends to save funds.  However, as in California, the cost may be higher than the benefit even though it is a proven strategy for containing health care costs in Workers Compensation. The goal is to reduce

What Is A Planned Retention?

Term Of The Day – Planned Retention This is a risk financing term that refers to retention of losses by an organization or business as a result of a conscious decision. The organization makes a decision to assume the exposure while fully aware of the loss and exposure. Planned retention

Is A Payout Profile Important?

Payout Profile  – Term Of The Day The payout profile or LDF are important to a company’s  return on investment. This is becoming very important to recently founded Captives. The first few years that a Captive is in existence are the make or break years. LDF’s (Loss Development Factors) go

What Does Strategic Risk Management Cost?

Term Of The Day – Strategic Risk Management Strategic Risk Management (SRM) is the identification, assessment, and management of risk in an organization’s business strategy. When risks are realized under this process, action is taken swiftly. SRM involves predicting how possible events will affect the strategy and it’s execution, and what

Is Workers Comp Claims Made And Reported Policy?

Term Of The Day – Claims Made And Reported Policy A Claims Made and Reported policy has many similarities to a Workers Comp policy.   I often speak about reporting Workers Comp claims ASAP. While Workers Comp policies are not this type of policy. Many aspects are similar.   Claims

Expected Losses – Where Are They Located On My EMod Sheets?

Expected Losses – What Are They and Where To Find Them? The Expected Losses for an employer is the amount of loss an average firm reporting the same exposures in the same classifications would have had during the Experience Period (usually three policy years). Each rating year the NCCI or

Pure Captive

Term Of The Day – Pure Captive A pure captive is the most basic of all captive arrangements. In the case of a “pure” or “single parent” captive insurer, the financial stability of the third party is completely dependent on the financial health of the parent. Commonly, the assets of such

Partial Retention And Workers Comp Deductible Comparison

Partial Retention And Deductible Comparison Partial retention is a very common risk management strategy. In Workers Compensation, partial retention is usually attained by using one of the following strategies: Self insurance with reinsurance in case of catastrophic claims or a bad claims year Small deductible program Large deductible program I

Other States Coverage In All Workers Comp Policies – Probably Not

Term Of The Day – Other States Coverage Workers Compensation insurance can be very tricky when it comes to other or all states coverage.  Many employers such as trucking/transportation companies are in dire need of having other states coverage for their drivers. Workers Comp used to be written on an all

What Is A Cell Captive?

Term Of The Day – Cell Captive A cell captive is either a rent-a-captive or a sponsored cell captive. The main goal is to lower risk by separating the underwriting data and results into distinct entities. This allows for each cell to only be responsible for its cell and not for

Aggregate Stop Loss Reinsurance

Term Of The Day – Aggregate Stop Loss Reinsurance The aggregate stop loss reinsurance is a  type of reinsurance is becoming very rare and expensive. A form of excess of loss reinsurance which indemnifies the reinsured against the amount by which the re-insureds  losses incurred during a specific period exceed either

Insurer Sponsored Agency Captive

Term Of The Day – Insurer Sponsored Agency Captive These types of captives are sponsored by very large insurance carriers. They are almost a hybrid type of captive as the operation is borrowed from an agency captive and a cell captive. On the surface, they seem like any other captive.

Residual Market (RML) Insures A Large Proportion Of Employers

 Term Of The Day – Residual Market (RML) One of the reasons that alternative Workers Comp insurance is becoming so popular over the last few decades. Some states have enormous residual market losses that must be passed along to policyholders of regular voluntary market insurance. The RML now insures approximately

Onshore Captive

Term Of The Day – Onshore Captive The onshore captive are a viable alternative to offshore captives such as Bermuda. The oldest and largest onshore domicile is Vermont. The states that are now domiciles for onshore captives are: Alabama Arizona Arkansas Colorado Delaware District of Columbia Florida Georgia Hawaii Illinois

Certificate of Compliance

Term Of The Day – Certificate of Compliance The certificate of compliance is important doc.A certificate which authorizes that a company is in compliance with municipal, state, or industry specifications, is a very important document for many business models. A compliance certificate can come in many forms; as a city

Broad Form Hold Harmless Clause

Term Of The Day – Broad Form Hold Harmless Clause This is the most dangerous of the three types of Hold Harmless agreements. Broad form hold harmless clause means the subcontractor applying for an insurance policy: Assumes all related liability for accidents Its own negligence General contractor negligence Combined negligence

Is Unfunded Self Insurance Good Risk Management Technique?

Unfunded Self Insurance Is High Risk Unfunded Self Insurance can lead to a company actually folding if there are enough claims that were never placed in a budget. These insureds do not usually have an accounting of the reserve funds required to meet future claims. The money is never really

Catastrophe Cover

Workers Comp Catastrophe Cover = Massive Losses Workers Comp catastrophe cover deals with massive losses.  Self Insured Employers may sometimes use a highly recommend risk management technique for Workers Compensation losses. Catastrophic excess insurance can save a company’s insurance budget or may even save the company in case of a

Ambulatory Care

Term Of The Day – Ambulatory The definition of ambulatory care is any medical care delivered on an outpatient basis. Increasing numbers of medical conditions can be managed without admission to a hospital. Many medical investigations can be performed on an ambulatory basis, including blood tests, X-rays, endoscopy and even biopsy

Operational Risk Management (ORM)

Term Of The Day – Operational Risk Management A continual cyclic process which includes risk assessment, risk decision making, and implementation of risk controls, which results in acceptance, mitigation, or avoidance of risk. I thought it would be best to cover two very simplistic models for ORM. The US Department of

Vis Major

Term Of The Day – Vis Major Vis Major means act of God or an unavoidable accident or calamity. Almost all insurance policies have a Vis Major clause in them. It can be the basis for a denial of insurance coverage.   ©J&L Risk Management Inc Copyright Notice

Retention

Term Of The Day – Retention 1) Assumption of risk of loss by deductibles, noninsurance, or self-insurance. Retention can be unintentional when exposures are not identified, or intentional. (2) In reinsurance, the net amount of risk the ceding company keeps for its own account.   ©J&L Risk Management Inc Copyright

Personal Risk Management (PRM) Definition

Term Of The Day – Personal Risk Management Personal Risk management focuses on how individuals can protect their wealth by risk management. The two areas of most concern are the insurance industry’s consumer products and employee benefits: Insurance: Auto insurance (Deductibles, liability, collision, comprehensive) Health insurance (Deductibles, co-pays, etc.) House

BCAR

Term Of The Day – BCAR BCAR = Adjusted Surplus / Net Required Capital AM Best invented this term. It is a test of the insurance carrier’s Balance Sheet. Having an unhealthy balance sheet is one of the steps for an insurance carrier to start down the path of insolvency.

Reinsurance Pool

 Term Of The Day – Reinsurance Pool Pooling risks from across a certain population can minimize premium variances between groups and premium fluctuations per group. A reinsurance pool covers the excess costs associated with high-risk insureds from numerous employer groups. A high-risk insured is one who is likely to generate

Personnel Risk Can Be Internal or External

Term Of The Day – Personnel Risk Refers to risks to a company’s operations that either concern or are caused by personnel. Personnel risk includes: Fatigue and exhaustion Accidents and illnesses Obsolete professional skills Personal or job-related disputes Unintentional human error Info leaks or theft Personnel risk analysis includes these

Retrospective Rating Requires Heavy Loss Control Efforts

Retrospective Rating Requires Great Work Comp Risk Management Retrospective rating is an individual risk rating plan that is an optional plan. Both the employer and the insurance carrier must agree to the Retrospective Rating Plan. This type of rating plan may be applied on either an interstate or intrastate basis.

Terrorism Risk Insurance Act (TRIA)

Term Of the Day – Terrorism Risk Insurance Act A Terrorism Risk Insurance Act of Worker Comp.Federal law signed into law by President Bush in 2002. . The Act created a federal “backstop” for insurance claims related to acts of terrorism. The Act is intended as a temporary measure to

Is IBNR (Incurred But Not Reported) Legal And How Is It Calculated?

IBNR – Incurred But Not Reported Is An Estimate  (Incurred But Not Reported) IBNR confused many in the WC community.  When a policy of insurance is written it will typically cover a defined (often 12 month) period from inception of the policy. When the policy is sold, a premium is

What is a Reinsurance Aggregate ?

Term Of the Day – Reinsurance Aggregate (a) The dollar amount of reinsurance coverage during one specified period, usually a year, for all reinsurance losses sustained during such period. (b) A limit of an insurance policy naming the most it will pay for all covered losses sustained during a specific

Annual Aggregate Deductible (AAD)

Term Of The Day – Annual Aggregate Deductible A collective type of deductible that can be used as a great risk management tool. The annual aggregate deductible (AAD) enables an insured to protect itself from numerous small claims by limiting the amount of deductible they pay per policy year. A

Records Retention

Term Of The Day – Records Retention The length of time that closed Workers Compensation claims file material should be retained by the insurance carrier, employer, or TPA. Most states have a minimum records retention law such as seven years after the file is closed. I do not recommend ever

Earned Surplus

Term Of The Day – Earned Surplus Earned surplus for Workers Compensation insurance carriers, mutuals, captives, self-insureds, risk retention groups and captives, comes from the basic formula Assets = Liabilities + Capital. Once all claims and expenses are paid (liabilities) then the surplus can be paid out to shareholders as

Acquisition Costs

Term Of The Day – Acquisition Costs Workers Comp policy acquisition costs (in most states) are broken down into four areas: Agent Commissions Premium tax Second Injury fund tax Other costs They are considered as pro-rata on the current and future company balance sheets centered around the anticipated investment income.

Stop Loss Reinsurance

Term Of The Day – Stop Loss Reinsurance Protects a cedent against an aggregate amount of claims over a period, in excess of a specified percentage of the earned premium income. Stop loss reinsurance: Does not cover individual claims therefore it is bulk insurance. The reinsuer’s liability is limited to

Test Mods Great For Budgeting Workers Comp Premiums

Test Mods Are Difficult Due To Correct Inputs Required We often calculate Test Mods for employers of all types so that they can properly budget for their next few years Workers Comp expenditures. There are many software packages that will calculate them such as ModMaster. There is an infinite number

Certified Risk Manager (CRM)

Certified Risk Manager Term Of The Day The CRM program is sponsored by the National Alliance for Insurance Education and research. From their website www.scic.com – The Certified Risk Manager International (CRM) designation demonstrates that you are knowledgeable in all areas of managing risks, hazards, and exposures. The five courses

Return To Work Program (RTWP) Great Risk Management Tool

Return To Work Program (RTWP) Term Of The Day A Return To Work Program (RTWP) is one of my Five Keys To Cutting Your Workers Compensation Costs. An RTWP program is a great long term risk management technique to reduce Workers Comp costs. The RTWP cuts the period of Temporary

Disclaimer

Term Of The Day – Disclaimer A Disclaimer flags an incomplete audit.  An accountant or auditor’s statement which says the required audit was not complete. The statement may have been issued because the auditor has not received all the pertinent information to do all of the required audit work. Because

Payroll Limitation

Term Of The Day – Payroll Limitation   For Workers Compensation, this limitation applies to executive officers and classifications with notes that indicate payroll limitation. The payroll on which premium is based shall exclude that part of the employee’s average weekly pay in excess of the applicable weekly limitation. The

General Exclusions

Term Of The Day – General Exclusions General Exclusions cover unique exposures.   In Workers Compensation, most employees are assigned one classification code. Certain operations present a unique exposure to hazard that is not common or prevalent in most industries. Employees who are engaged in these activities must be assigned

Certificate Holder

Certificate Holder-Workers Comp Term  The Certificate Holder is the entity that actually purchased the policy from the insurer. They are shown on the certificate of insurance as the named insured. The Holder is responsible to produce the proof of insurance. ©J&L Risk Management Inc Copyright Notice

Transfer Of Right Of Recovery Usually Means Waiver of Subrogation

Transfer Of Right Of Recovery = Waiver A transfer of right of recovery for Workers Comp usually involves a very specific type of waiver. The act of giving up the right by an insurer of collecting from another entity for payment on behalf of the insured. In current standard policies,

Partial Retention Is Great Risk Management Technique

Partial Retention Can Reduce Premiums and Budgets The Partial Retention of a risk can be thought of as either using a deductible or an umbrella to cover catastrophic events that would ruin certain insurance programs. Your car insurance deductible can be thought of as a partial retention.   If you

Deposit Premium

Term Of The Day – Deposit Premium The Deposit premium is unique from regular insurance premiums, because they are refundable should either the insured or the insurer chose to terminate the perpetual insurance. Premium required by an insurance company for plans subject to premium adjustment. The initial provisional premium is

What Are “A” Rates ?

Term Of the Day – “A” Rates When analyzing the premiums that very large deductible insureds pay their carriers, we often come across what is called an “A” rate. The underwriter will set the rates on an “ala carte” basis only analyzing the company on its own merits and not

Standard Exceptions

Term Of The Day – Standard Exceptions The Standard Exceptions in a Workers Comp policy reduce premium payouts for the safer workers at a give employer. Employees that are not classified under the governing classification code. Almost all business have standard exception employees. Clerical (Class Code 8810) and Drivers (Class

Scooping Ice Cream Results in Compensable Injury

Term Of The Day – Scooping Ice Cream Scooping ice cream can be hazardous? Recently, an employee of an ice cream store had her claim denial reversed and received Workers Comp Benefits for her shoulder injury caused by scooping ice cream in a very busy store. Apparently, it is not

Endorsements Are Under Radar Part of Work Comp Policy

Endorsements Can Change Policy Many Times  Policy endorsements change the policy as many times as the carrier wishes.  Workers compensation policies may need some type of change or addition during the course of the policy year. These endorsed changes for Workers Comp policies may possibly occur due to changes in

Due Diligence Overused Term But Necessary in Work Comp Insurance

Term Of The Day – Due Diligence The Due Diligence is one of those overused terms in insurance, especially Risk Management.  The term was started with the post stock market crash and resulting depression. Congress passed the Securities Act of 1933.  The term was born out of that Act.  Due

Who Is First Named Insured On The Policy?

Term Of The Day – First Named Insured The entity or person named first on the dec page of the policy. The first named insured or primary has certain rights or responsibilities that are not afforded to the other additional insureds on the policy. Some examples of these rights would

Is A Deductible Plan Similar to Auto Insurance?

Deductible Plan – Workers Comp Term A Deductible Plan for Workers Comp comes in two basic sizes.  The insurer retains all the claims handling responsibilities regardless of the size of the plan. There are two main categories in Workers Compensation: Small deductible – the employer retains a small amount of

Are Competitive State Funds The Same As Regular Carriers?

Competitive State Funds Still Exist Across The US – Updated 2019 Facilities that are state owned and operated that directly compete with commercial carriers. The competitive state funds usually only write Workers’ Comp policies that are intrastate (inside their own borders). Not all states participate in this type of fund. 

Is A Binder Used In Workers Compensation?

Binder – Term Of The Day A binder can be used in WC, but is not recommended.  A temporary but legal agreement that provides proof of coverage until a policy can be issued. Provided by agents or carriers, binders should clearly define the terms of the policy that will be

Who Is An Additional Insured ?

Additional Insured-Workers Comp Term One of the most common additional insured is a subcontractor. The subcontractor may not have the proper insurance. The main contractor may choose to cover the subcontractor by an endorsement. An individual or entity that is not automatically included as an insured under the policy of

Does An Interstate Rating Cover All States?

Term Of The Day – Interstate Rating An Interstate rating cover a an experience modification factor across more than one state. These ratings are calculated by the NCCI for employers whose previous workers compensation policies have included payroll for more than one state. While most states recognize the interstate rating

Loss Reserve Stability Definition

Term Of The Day – Loss Reserve Stability An actuary’s ability to project Workers Compensation loss reserve or pricing in the future is based upon numerous inputs. One of those inputs is the amount of time covered by the data. If the actuary has 10 years of data, he/she will be

Qualitative Claim Auditing

Term Of The Day – Qualitative Claim Auditing Qualitative Claim Auditing refers to a review of claim files to explore the level of claims handling adequacy. The best way to accomplish a qualitative audit is by comparing the file handling to the claims manual using a scoring sheet. A qualitative

Seasonal Risk

Term Of The Day – Seasonal Risk A seasonal risk for Workers Compensation is when the workers are hired to work only certain times of the year. Holiday department store workers are seen as a seasonal risk business as are fruit harvesters. ©J&L Risk Management Inc Copyright Notice

Third Party Administrator Adjusts Workers Comp Claims For Self Insureds

Third Party Administrator (TPA) Is Not An Insurance Carrier A firm hired to handle Workers Compensation claims by contract. Third Party Administrator (TPA) usually work for self insureds on a yearly renewable basis.  Most governmental organizations hire TPA’s usually are paid so much per incoming medical only, lost time, or reportable

Underwriter Is Very Important Position In Workers Comp

Term Of The Day – Underwriter An underwriter works under the radar most of the time. In the broadest sense, an underwriter is the person who “underwrites” his name to the conditions of the policy. In Workers Comp, an underwriter’s job is to evaluate a given risk for plausibility and

What Is A D-Ratio in Workers Compensation – How Is it Calculated?

D-Ratio Is Associated With Each Class Code  D-Ratio is also known as the discount ratio. NCCI or your State Rating Bureau uses the discount ratio to determine the portion of the losses that are expected to be primary losses ($15,000 or less). A D-Ratio can vary by the rating state

Risk Avoidance

Risk Avoidance-Workers Comp Term In Workers Comp the term risk avoidance refers to one of the most obvious way to reduce risk to the economy of the business. Just as it sounds, avoid the occurrences in your daily business that have led to risk or claims that have happened in

Adjudication Is Day In Court

Adjudication – Workers Comp Determination The Workers Comp term Adjudication is the process in which a judge examines the evidence, arguments and legal argument brought by two opposing parties. After examination, a decision can be made to the determine the rights and obligations between the parties involved. There are three

Is Accident Year Data A Good Basic Statistic?

Accident Year Data – Workers Comp Term Accident year data is often used for statistical comparison analysis. Most of the time when I have Accident Year Data, the information involves: The inclusion of all carrier loss and exposure data (or that of a group of carriers or within a book

Are Policy Provisions Important?

Policy Provisions – When Reality Hits The Policy Provisions trip up employers when filing claims.  Even adjusters sometime have trouble with the policy terms.  The section of an insurance policy that defines the requirements of both the carrier and the insured. This section includes information about loss reporting and settlement,

Prohibited Risk Employers And Assigned Risk Programs

Term Of The Day – Prohibited Risk A Prohibited risk is any class of business that has been excluded by the underwriters of an insurance carrier. These classes of businesses will not be insured under any circumstance. This is also known as uninsurable risk. Workers Compensation insurers avoid certain markets resulting

Preferred Risk Will Usually Have Lower Premiums

Term Of The Day – Preferred Risk Preferred risk is any risk that is considered to be a better risk. These risks have a lower expectation of incurring loss and if losses are incurred, they will be less significant. For example, a business who has a effective safety program in place

What is A Net Loss In Workers Compensation?

Net Loss Is The Final Countdown The term Net Loss is seldom used in Workers Compensation. The figure  represents the final paid loss regardless of the reserves that were set on the claim.   The final paid loss may differ from the Total Incurred if the file was closed after the

Did A Loss Constant Cause Me To Pay Higher Premiums?

Term Of The Day – Loss Constant In workers comp, loss constant is a flat amount added to the premiums of smaller businesses.The purpose of adding it in is to offset any unusual or more than average losses or claims. The smaller business can have a higher loss ratio. The Loss

Does A Hazard Increase Work Comp Premiums?

Hazards Increase Work Comp Premiums  Most hazards cause workers comp premiums to increase eventually.  Any condition that increases the chance that there will be a loss. Hazard exist in every workplace. Examples could be improper storage of office supplies which contain chemicals, or a slippery floor in a kitchen. Recognizing

Is First Dollar Coverage Provided in WC Policies?

Term Of The Day – First Dollar Coverage The first dollar coverage in A WC policy is the norm. The type of insurance in which payment of all losses up to the policy limits is provided without the use of deductibles. Because the insurer assumes more risk, the premiums will

Can There Be Coinsurer on WC policy?

Coinsurer-Term Of The Day This is sometimes referred to as pie chart insurance (coinsurance). One of the parties that provides additional insurance to the same person or policy. A Coinsurer provides partial coverage along with other coinsurers. Coinsurers are generally used when the amount being covered is too large for

Do I have Unearned Premium On My Policy?

 Unearned Premium-Workers Comp Term The unearned premium represents the portion of a Workers Comp Policy Premium that has been paid beyond the current period. The Unearned part of the term means the insured has not yet used that part of the premium in their policy. If the insurer or insured

What Is A Wrap Up Policy?

Term Of The Day – Wrap Up Policy Also known as a Contractor and/or Owner Controlled Insurance Policy, a Wrap Up Policy is a single policy naming all participants in a project as insureds. The use of a Wrap Up Policy for workers compensation provides coverage without each individual worker or

Risk I.D. # – Who Assigns it?

Term Of The Day – Risk I.D. # An employers Risk I.D.# is assigned by it’s rating organization. Each employer’s Risk I.D. # is uniquely it’s own. Through the use of this system, each employer’s past Workers Compensation experience can be isolated and tracked.   ©J&L Risk Management Inc Copyright Notice

Ballast Value Rights Workers Compensation Rating Ship

Term Of The Day – Ballast Value The Ballast Value comes from an old sailing term.  Sailors were known to put large rocks in the bottom of their ships to enhance stabilization.   In general, the definition of Ballast is something, such as a weight, added to give stability , usually

ERM – Enterprise Risk Management

Term Of The Day – ERM ERM is the acronym for Enterprise Risk Management.  A Practice that attempts to ensure the risk position of a company or organization as it tries to satisfy it’s goals. There are just a few steps to this practice but they are definitive. One is

Are There Explanation of Benefits (EOB) in Workers Compensation?

Explanation of Benefits (EOB)-Term Of The Day The Explanation of Benefits (EOB) is a new term in the Workers Compensation industry. Until recently, EOBs were common to the Health Insurance industry and are sent out to claimants so they are aware of the benefits that their insurance carrier is paying

What Is Retaliatory Employment Discrimination Act (REDA)

Retaliatory Employment Discrimination Act Is Important The Retaliatory Employment Discrimination Act involves Workers Comp in certain cases.   The Department of Labor’s Employment Discrimination Bureau (EDB) is responsible for the enforcement of the Retaliatory Employment Discrimination Act, or REDA. Through this act, employees who are involved in a Workers Compensation

Are Death Benefits Payable In WC?

Term Of The Day-Death Benefits  Death benefits are a very important part of  a claim where the employee expired due to an on-the-job-injury.   Under Workers Compensation, benefits are paid to the spouses and dependents of a worker who dies as the result of a work related injury or illness.

Temporary Total Disability Benefits Important Facet Of WC Claim

Temporary Total Disability Benefits Are Very Important To The Injured Worker Temporary Total Disability is one of the most common terms. in Workers Compensation. The acronym is TTD.  This level of Workers  Comp disability reflects an injury that has rendered the employee completely unable to perform any job functions on

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