Term

Definition

California Workers’ Compensation Institute (CWCI)

organization funded primarily by insurers and employers to conduct scholarly research on California WC

cancellation clause

WC policy provision that controls how the employer or the insurer can cancel the insurance coverage

carrier

for WC, a term that is equivalent to insurer

casual employee

informal worker-- possibly a part-timer, family member, or volunteer-- who may or may not be covered by state WC laws

certificate of insurance

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

certificate of self-insurance

written authorization by a state regulator allowing an employer to fund its WC obligations without insurance

choice of medical provider

while a majority of states allow the injured worker to make this choice, many states place significant limits on choice or change of medical provider

Civil Rights Act of 1964

US federal law that made discrimination against workers based on race and gender illegal

claim administrator

a business that handles claims

claim for benefits

some states require an injured worker to file both a notice of claim and a claim for benefits; the notice period is typically much shorter than the time period to file a claim for benefits

claims specialist

person who resolves claims by determining the amount of loss or damage

claimant (clmt)

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

classification audit

audit of classification codes done by an advisory organization to resolve a dispute between the insurer and employer

classification code (class code)

systematic arrangement of jobs into categories according to certain criteria based on statistical experience; leads to the determination of rates

clincher, clincher agreement

term used in some states for a full and final settlement

co-pay, medical treatment

for medical treatment, a partial payment by the patient (“coinsurance payment”); WC does not normally have any co-pays

coal workers pneumoconiosis (CWP)

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

collateral

for loss-sensitive programs, a deposit, promissory note, or letter of credit against losses that will be billed to the policyholder later

combined loss ratio

a ratio of losses to premium that includes the insurer’s expenses to underwrite the policy and administer the claims

coming and going rule

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

Commercial General Liability policy

A business insurance policy that excludes claims from injured workers

common law

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

communicable disease

a disease that can easily spread from one person to another

commutation

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)

comorbidity

for WC, a separate medical condition, not caused by work, that hinders recovery from the work injury or illness (e.g., diabetes, obesity)

comparative negligence

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)

compensability

the decision whether the worker's injury is owed under the jurisdiction's WC statutes or not

compensable

owed to the injured worker under the jurisdiction’s WC statutes

compensating balance arrangement

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

compensation rate

wage replacement benefit rate, often weekly, for a worker with a compensable claim

competitive state fund

WC insurer established by a state to compete with private WC insurers

composite rating

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)

compromise and release agreement (C&R)

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

compulsory coverage

any type of insurance required by law; WC is a compulsory coverage for most employers in most states

conclusive presumption

see presumption, conclusive

concurrent award

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)

concurrent employment

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

concurrent jurisdiction

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)

consequential bodily injury

same as loss of consortium claim

constructive notice of injury

situation where the employer is aware of an injury even though the worker has not formally reported it

continuance

postponement of a hearing or other proceeding to a subsequent day or time

contribution

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

contributory negligence

any situation where the one claiming damages was one of those who caused the accident; prior to WC, contributory negligence prevented an injured worker from recovering damages from the employer

converted losses

in retrospectively rated plans, subject losses multiplied by the loss conversion factor

corporate officer

person authorized by a corporation to make certain decisions; not automatically covered by WC

corporation

a business organized and incorporated under specific state laws; most larger businesses are corporations

cost shifting

for WC, this most often refers to attempts by medical providers to seek increased reimbursement from WC payers as a result of the larger payers of medical care (group health and Medicare) control costs more effectively

cost-of-living adjustment (COLA)

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

cost-plus basis

older method in use in some states to determine reimbursement rates for medical procedures

coverage

the extent of protection afforded by an insurance policy

Coverage B

outdated term for the employers' liability insurance provided in Part Two of the standard WC policy

coverage issue

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

CPT codes

see Physicians Current Procedural Terminology (CPT codes)

credit

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)

cumulative trauma (CT)

injury that occurs over time as a result of repetitive stress to a body part (opposite of a specific injury)