Term

Definition

earning capacity benefits

wage replacement benefits based strictly on loss of earning capacity, with no consideration of lost physical function

early return to work

situation where the worker’s job duties are modified to meet work restrictions from the injury, thus resulting in a return to work sooner than if only usual and customary duties were available

early return to work program

formalized strategy to generate early return to work opportunities

economic reality test

one of the factors considered in deciding whether a worker is an independent contractor or not-- how dependent is this worker on the hiring entity for his or her income? Independent contractors typically have multiple sources of income

EDI

abbreviation for electronic data interchange; for WC, this usually refers to the requirement for insurers and claim administrators to send injury data to the state WC agency, including first report of injury (FROI), subsequent report of injury (SROI) and medical bill detail data

elective coverage

WC coverage purchased by a business that is not required by state law to have it

emergency hearing

special type of hearing to handle situations which require especially quick action, most often on issues of medical necessity or compensability

employee (EE)

worker performing duties essential to the business and under the employer's direction of the means and methods to accomplish the work -- an employee is always a worker, but workers are not always employees (they can be independent contractors)

employee leasing

scenario where a labor contractor leases workers to a special employer

Employee Leasing Client Endorsement

endorsement to the WC policy that extends coverage to the special employer that is leasing employees from the named insured

Employee Leasing Client Exclusion Endorsement

exclusion endorsement to the WC policy where the named insured’s policy does not provide coverage to the special employer leasing its employees

employer (ER)

any person, corporation, firm, partnership, voluntary association, joint stock association, or government entity using the services of one or more employees for pay

employer knowledge

in some states, there must be employer knowledge (at the time of hire) of a preexisting condition to recover from the subsequent injury fund

employer mutual association

specific type of self-insurance group permitted in some states

employers liability coverage (EL)

this coverage, provided by Part Two of the standard WC policy (or as an endorsement to a general liability policy in monopolistic states), responds to injury claims from workers for damages not covered by state WC statutes

Employers Liability Coverage Endorsement

typically used in monopolistic states where private insurers cannot write Part One WC coverage - see employers liability coverage (EL)

Employment Retirement Income Security Act (ERISA)

ERISA regulates some non-occupational disability benefits but does not apply to WC benefits

endorsement

added language that explains, increases, or limits a WC policy

Equal Employment Opportunity Commission (EEOC)

US government agency that enforces The Americans With Disabilities Act

ergonomic evaluation

physical inspection of a worker's work area, either by someone trained in ergonomics or the worker's supervisor, to identify modifications that can be made to reduce physical stressors, especially repetitive ones

ergonomics

science of reduction of physical stress in a work area, especially through proper alignment of the human body to tasks

ergonomist

specialist in ergonomics

ERISA

see Employment Retirement Income Security Act (ERISA)

error of fact

in a WC appeal, an allegation that the administrative law judge wrongly interpreted a fact in making a decision

escrow fund

a claim payment fund used by a claims administrators to pay claims

error of law

in a WC appeal, an allegation that the administrative law judge wrongly interpreted the law in making a decision

estimated premium

the premium shown on the information page is an estimated premium; the final premium is determine after the policy period ends

excess loss insurance

for self-insurers, a way to limit claim costs above a specific amount

excess loss premium (ELP)

for retrospective rated WC plans, a premium paid to limit single losses within the plan

excess loss premium factor (ELPF)

same as excess loss premium

excess losses

in the experience modification factor, the part of any one incurred loss that exceeds $5000

excess WC insurance (XWC)

insurance coverage purchased by self-insured employers to cover losses that exceed the maximum amount that the state allowed the employer to self-insure

exclusion endorsement

added language that restricts a WC policy

exclusion form

legal document that sole proprietors, partners, officers, or directors use in some states to choose to NOT have their own work injuries or illnesses covered by WC

exclusive remedy doctrine

A principle that holds that the injured worker's only legal recourse against the employer for the injury is the WC benefits provided by the state WC statutes – some states have exceptions to the exclusive remedy doctrine

exclusive state fund

see monopolistic state fund

exemplary damages

same as punitive damages

expected costs

for underwriting purposes, the estimated total cost for the policy period based on expected losses

expected losses

for underwriting purposes, the amount of losses likely during the next policy period

expense constant

a charge that covers expenses common to all WC policies, regardless of the premium amount

experience modification factor (Ex Mod, experience modifier)

adjustment to manual premium, calculated by an advisory organization such as NCCI, based on historic loss and payroll data of a particular insured

experience modifier

same as experience modification factor

experience-rated policy

WC policy based on experience rating

experience rating

Comparison of an employer’s WC losses to other businesses that do similar work; mandatory for most employers; results in an experience modification factor

Experience Rating Modification Factor Endorsement

endorsement to a WC policy used when the experience modifier is not available at the time the policy is first issued; says the ex mod  will be endorsed onto the policy once available

extra-hazardous occupation

in some states, a misnomer that really means any business required to furnish WC benefits; in a few states, only extra-hazardous industries have to purchase WC coverage (the term comes from the early days of WC, when many businesses were not required to have WC coverage); in other states, an employer that is required to implement risk control approaches such as safety committees

extraterritorial provision

reciprocal agreement between two state regulators that prevents nonresident workers from filing WC claims as long as they are covered for WC in their residence state