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Term
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Definition
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cancellation clause
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WC policy provision that controls how the employer or the insurer can cancel the insurance coverage
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carrier
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for WC, a term that is equivalent to insurer
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casual employee
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informal worker-- possibly a part-timer, family member, or volunteer-- who may or may not be covered by state WC laws
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certificate of insurance
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written document, usually one page, provided by an insurer or insurance broker that gives basic information about a WC policy currently in force; an employer uses it to show others that it purchased WC insurance
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certificate of self-insurance
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written authorization by a state regulator allowing an employer to fund its WC obligations without insurance
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claim administrator
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a business that handles claims
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claims specialist
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person who resolves claims by determining the amount of loss or damage
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claimant (clmt)
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older term for injured worker; generic term for any person who makes a claim for WC benefits – claimants include surviving dependents of an employee allegedly killed by a compensable injury or disease
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classification audit
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audit of classification codes done by an advisory organization to resolve a dispute between the insurer and employer
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classification code (class code)
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systematic arrangement of jobs into categories according to certain criteria based on statistical experience; leads to the determination of rates
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coal workers pneumoconiosis (CWP)
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commonly known as black lung disease, one of the most problematic occupational diseases in US history -- CWP has its own special state and federal programs
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collateral
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for loss-sensitive programs, a deposit, promissory note, or letter of credit against losses that will be billed to the policyholder later
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combined loss ratio
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a ratio of losses to premium that includes the insurer’s expenses to underwrite the policy and administer the claims
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coming and going rule
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principle in most WC systems that generally holds that workers are not covered for WC while coming to and going from their normal work location
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Commercial General Liability policy
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A business insurance policy that excludes claims from injured workers
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common law
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law derived from judges' decisions rather than legislation; developed in England, a thousand years before the United States was founded, the traditional unwritten law based on custom and usage
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communicable disease
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a disease that can easily spread from one person to another
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commutation
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payment of WC benefits in a shorter time frame than is normal, sometimes requiring a monetary reduction to the present value of the benefits (also see advanced payment)
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comparative negligence
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in a civil suit, a reduction in the damages owed by a responsible party because of the plaintiff's own wrongdoing (can affect WC subrogation recovery)
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compensability
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the decision whether the worker's injury is owed under the jurisdiction's WC statutes or not
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compensable
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owed to the injured worker under the jurisdiction’s WC statutes
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compensating balance arrangement
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in loss-sensitive programs, the employer may agree to keep an agreed average amount deposited in some account as part of the insurer’s collateral requirements
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compensation rate
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wage replacement benefit rate, often weekly, for a worker with a compensable claim
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competitive state fund
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WC insurer established by a state to compete with private WC insurers
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composite rating
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in contrast to schedule rating and experience rating, composite rating allows large, complex risks to be underwritten using one exposure base (it simplifies the process)
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compromise and release agreement (C&R)
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final settlement where the injured worker agrees to a compromise payment (usually a lump sum) in exchange for releasing the employer from all further obligation for the claim
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compulsory coverage
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any type of insurance required by law; WC is a compulsory coverage for most employers in most states
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concurrent award
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for WC, the term is most often used to describe dual decisions to provide benefits under both state WC and longshore (in most cases, there are offsets that prevent double payments)
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concurrent employment
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simultaneous employment by more than one employer – in some jurisdictions, the compensation rate must be based on the average wages from ALL jobs the employee is unable to work as a result of the injury or disease
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concurrent jurisdiction
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for WC, this term is most often used to describe the dual WC benefits available to maritime employees from both state WC laws and longshore (these workers are eligible for both, but in most cases there are offsets that prevent double payments)
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consequential bodily injury
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same as loss of consortium claim
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constructive notice of injury
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situation where the employer is aware of an injury even though the worker has not formally reported it
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continuance
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postponement of a hearing or other proceeding to a subsequent day or time
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contribution
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for WC, a situation where another employer or another insurer owes part of the WC benefits, either by direct payment or by repayment to another WC payer
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converted losses
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in retrospectively rated plans, subject losses multiplied by the loss conversion factor
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corporate officer
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person authorized by a corporation to make certain decisions; not automatically covered by WC
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corporation
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a business organized and incorporated under specific state laws; most larger businesses are corporations
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cost-of-living adjustment (COLA)
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some jurisdictions require annual cost-of-living adjustments to an injured worker's indemnity benefits; the percentage increase for some COLAs is set in the WC statutes; others are tied to some measurement of inflation
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coverage
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the extent of protection afforded by an insurance policy
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Coverage B
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outdated term for the employers' liability insurance provided in Part Two of the standard WC policy
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coverage issue
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a claim where the facts raise a question as to whether the WC insurance policy covers the injury (not the same as a compensability issue); an example is a compensable injury that occurs in a state not on the WC policy
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credit
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for experience rating, a reduction in (credit to) the premium paid due to an experience modification factor of less than 1.0 (loss experience is better than that of similar employers)
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cumulative trauma (CT)
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injury that occurs over time as a result of repetitive stress to a body part (opposite of a specific injury)
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