General terms

Question 1

A formal request from an insurance company for coverage or compensation for a covered loss or policy event.

Answer 1

Claim

Question 2

Any injury or damage that the insured suffers because of a covered accident or misfortune.

Answer 2

Loss

Question 3

A person or organization covered by insurance.

Answer 3

Insured

Question 4

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.

Answer 4

Carrier

Question 5

Process of evaluating risk of insuring someone or something, to determine if it’s profitable for the insurance company to accept the risks.

Answer 5

Underwriting

Question 6

Trained insurance professionals with specialized knowledge in risk assessment & determines whether they will insure something or someone and at what cost.

Answer 6

Underwriters

Question 7

Individual or company authorized to represent an insured in the purchase, servicing & maintaining insurance coverage with a designated insurer.

Answer 7

Agent of record

Question 8

Amount to be paid for an insurance policy.

Answer 8

Premium

Question 9

State of being legally responsible for something.

Answer 9

Liability

Question 10

A written law passed by a legislative body.

Answer 10

Statute

Question 11

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.

Answer 11

Subornation

Question 12

State of being at risk to a loss or claim.

Answer 12

Exposure

Question 13

Total amount paid to employee for work performed.

Answer 13

Remuneration

aka payroll

Question 14

4 digit number used to classify a specific job definition to help identify different workplace exposures.

Answer 14

Class Code

Question 15

When an employee works more than 40 hours. Additional hours are paid at a time and a half rate

Answer 15

Overtime

Question 16

Total amount paid to an employee before any taxes, deductions, premiums etc.

Answer 16

Gross Wage

Question 17

Losses paid to claimant during the reported period

Answer 17

Paid loses

Question 18

Losses reported to the insurer, but are still in settlement

Answer 18

Outstanding losses

Question 19

Paid losses + outstanding losses

Answer 19

Incurred losses

Question 20

Class of CW where injured employee is incapable of ever working anywhere. Will receive weekly wages

Answer 20

Permanent disability

Question 21

Works on a person’s mental/physical work performance capacity.

Answer 21

Vocational Rehab

Question 22

Cost of operating the ins business exclusive of losses or claims

Answer 22

Expense

Question 23

Amount paid by carrier

Answer 23

Recovery

Question 24

An employee’s pre-injury earning capacity preceding a work related injury.

Answer 24

Average Weekly Wage

Question 25

The covered person making a claim or responsible for a loss

Answer 25

Claimant

Question 26

The injured employee has hired an attorney to represent their interests on the worker’s comp claim

Answer 26

Litigated

Question 27

A claim that has not been settled and/or payments are still being made

Answer 27

Open claim

Question 28

A claim that has been settled.

Answer 28

Closed claim

Question 29

The start date of an ins. policy

Answer 29

Inception date

Question 30

The end date of an ins. policy

Answer 30

Expiration date

Question 31

A statute for a claim where it was necessary for an injured employee to recuperate away from work

Answer 31

Disability

Question 32

A status for a claim where an injured employee required medical treatment but did not have to miss any work time.

Answer 32

Non-disability

Question 33

Payments made for an employee’s lost wages or a claim.

Answer 33

Paid compensation

Question 34

Payment made for the medical treatment of an injured employee.

Answer 34

Paid Medical

Question 35

Classification code that best describes the WC exposure of an employer’s business, determined by majority of payroll.

Answer 35

Governing Class Code

Question 36

The cutoff date for adjustments made to paid claims and reserve estimates in a loss runs report

Answer 36

Valuation Date

Question 37

An insured’s reported claims history for a specific policy period.

Answer 37

Loss Run Report

Question 38

A unique identifier that attaches an insurance claim/ loss to a specific worker

Answer 38

Claim Number

Question 39

The ultimate rate per class code after all debits and credits have been applied.

Answer 39

Net Rate

Question 40

A contractual provision where one party agrees to waive its right to pursue another party in the case of a loss.

Answer 40

Waiver of Subrogation

Question 41

A rating factor used to compare an insured’d claim and payroll history against other employers with similar operations.

Answer 41

Experience Modifier

Question 42

A rate the insurance carrier has filed with the state for a class code that is starting point for premium calculations.

Answer 42

Base Rate

Question 43

Manual Premium

Answer 43

= class code base rate X remuneration/100

Question 44

Credit or debits an insurer may offer depending on the safety practices and claims history of an insured.

Answer 44

Scheduled Rating (aka rating plan)

Question 45

A percentage discount dependent on the insured’s Total Standard Premium. Only policies which have exceeded state-standard minimum levels are eligible.

Answer 45

Premium Discount

Question 46

A policy admin fee to cover the costs incurred by the ins co

Answer 46

Expense Constant

Question 47

Terrorism

Answer 47

= remuneration / 100 X state terrorism factor

Question 48

Additional charges for the policy as mandated by the state.

Answer 48

Assessment (aka ‘state’ or ‘mandatory surcharge’)

Question 49

The payment plan assigned to the insured for the policy term.

Answer 49

Payroll Reporting

Question 50

Estimated Modified Premium

Answer 50

= estimated manual premium X experience modification rating

Question 51

The smallest acceptable premium acceptable premium for which an ins co will write a policy.

Answer 51

Minimum Premium

Question 52

The rate after all credits and debits without factoring in the experience modifier.

Answer 52

Interim Billing Rate

Question 53

An amendment to an insurance policy which adds, modifies, or eliminates coverage

Answer 53

Endorsement

Question 54

A land motor vehicle, trailer or semi-trailer designed for travel on public roads.

Answer 54

Auto

Question 55

A sudden, continuous or repeated exposure to the same conditions that results in “bodily injury” or “property damage”.

Answer 55

Accident

Question 56

The insured or 3rd party making the claim or responsible for a loss.

Answer 56

Claimant

Question 57

The amount paid to claimant for losses during the policy period.

Answer 57

Loss Paid

Question 58

The amount paid for medical payments to claimant during the policy period.

Answer 58

Med Paid

Question 59

The amount paid to claimant for insurance carrier-related expenses incurred during the policy period.

Answer 59

EXP Paid

Question 60

The amount recovered by the insurance carrier from the at-fault party’s insurance carrier for expenses.

Answer 60

Expense Recovery

Question 61

Short for deductible Recovery,’ it is the amount recovered by the insurance carrier from their insured’s deductible payment.

Answer 61

Deduct Recovery

Question 62

The damaged property’s salvage value deducted from the claim.

Answer 62

Salvage Recovery

Question 63

‘Subrogation Recovery”, it’s the amount the insured’s insurance carrier recovers from the at-fault party’s insurance carrier through subrogation.

Answer 63

Subro recovery