Term

Definition

maintenance and cure

term used for wage replacement (maintenance) and medical (cure) benefits paid under the Merchant Marine Act of 1920 (Jones Act)

managed care

for WC, strategies and tactics designed to generate quality, cost-effective medical outcomes – also called managed medical services

managed care organization (MCO)

medical organization that provides either medical treatment or review of medical utilization – preferred provider organizations and health maintenance organizations are examples of MCOs

manual classification

see classification code

manual premium

initial WC premium calculation, multiplying payrolls by appropriate rates, before applying any experience modifier, schedule credit, or premium discount

manual rate

rate developed by insurer using advisory loss costs or rates

marital status

required data collection for WC claims (typical values are single, married, and divorced)

Maritime Coverage Endorsement

endorsement to the WC policy covering exposure to Jones Act seamen

maritime employment

employment on or near navigable waters of the United States; maritime employees are limited to specific classes of employment, and are often covered by both the Longshore and Harbor Workers Compensation Act or the Jones Act and state WC

“market of last resort”

see residual market plan

matching deductible

see fronting arrangement

maximum compensation rate

highest wage replacement rate allowed by a WC statute -- maximum rates vary by state, date of injury, application of any COLAs, and the type of benefit

maximum cost

the most a policyholder would have to pay if “the worst” happened during the policy period; varies by program type

maximum medical improvement (MMI)

most commonly used term for the point in time at which the worker's medical provider determines that the worker has healed to the fullest extent that can reasonably be expected (in many states the determination of MMI paves the way to determine the extent of any permanent partial disability)

maximum retrospective premium

the most premium a policyholder will pay under a retrospective rating plan, regardless of the amount of incurred losses

mediation

informal dispute resolution process where a neutral person, with no authority to make a ruling or force a resolution, attempts to get the parties to agree; used in many states now prior to a formal hearing

mediator

the neutral party who leads a mediation

medical authorization

signed agreement by the injured worker that the claim administrator can obtain medical information to administer the WC claim – most states require the injured worker to sign such an authorization

Medical Benefits Exclusion Endorsement

Exclusion endorsement to the WC policy sometimes used in states that allow the employer itself to pay medical benefits (rather than the insurer paying these benefits)

Medical Benefits Reimbursement Endorsement

Endorsement to the WC policy sometimes used in states that allow the employer itself to pay medical benefits-- with this endorsement, the employer pays and then the insurer reimburses the employer

medical bill detail

for WC, this term is typically used in conjunction with EDI requirements

medical fee schedule

most WC regulators publish and periodically update schedules of the maximum fees payable to medical providers – many of these are now linked in some way to the RBRVS methodology used for Medicare reimbursement

medical malpractice

situation where medical providers fail to exercise the typical standard of medical care; in WC, additional treatment required as a result of medical malpractice is typically covered as part of the original claim

medical necessity

multifaceted test of whether WC should pay for a certain medical treatment -- factors considered include whether the treatment is necessary to restore functioning or merely preventive; part of accepted medical protocols for the condition; safe for the patient; a medical service rather than a social service; reasonably cost-effective

medical provider

for WC, any licensed medical professional who provides services for an injury

medical provider network (MPN)

same as preferred provider network (PPO)

medical records

medical information including bills, reports, charts, histories, and treatment notes

medical release

older term for medical authorization

medical-only claim (medical only, MO)

claim where no indemnity benefits have been paid or are likely to be paid

medically stationary

older term to indicate the injured worker has reached maximum medical improvement

Medicare allocation

informal alternative to Medicare set-aside agreement

Medicare Secondary Payer Act of 1980

federal law clarifying that Medicare is not obligated to pay any benefit that should be paid by a primary payer like WC

Medicare set-aside agreement

agreement between an injured worker and a WC payer that the worker will set aside a specified portion of a settlement to pay for future medical expenses that would otherwise have to be paid by Medicare

memorandum of agreement

written form that contains the formal agreement between a claim administrator and the injured worker specifying the type and amount of WC benefits to be paid

mental injury

injury that manifests strictly as a psychological disorder

mental-mental injury

psychological injury with no accompanying physical injury

mental-physical injury

psychological injury that later results in a physical injury (unusual)

mental stress claim

see mental-mental injury

Merchant Marine Act of 1920

more commonly known as the Jones Act, federal statute that provides benefits to sailors that are similar to those for railroad workers under FELA; not part of USL&H coverage

mergers and acquisitions

these business combinations create complications in determining the accurate experience modification factor

Migrant and Seasonal Agricultural Worker Protection Act (MSPA)

national law passed in 1983 to protect these workers; the law was not designed to cover work injuries that state WC programs should cover, but does require certain benefits be made available if these workers are injured while being transported (an exposure that might not be covered under state WC)

minimum compensation rate

lowest wage replacement rate provided for by a WC statute – minimum rates vary by state, date of injury, application of any COLAs, and the type of benefit

minimum cost

for underwriting purposes, the sum of all fixed costs assuming no losses

minimum premium

the lowest premium that the employer will pay, regardless of the actual remuneration during the policy period; designed to cover the insurer’s expenses to underwrite and issue the policy

minor (child) - illegally employed

employers who both knowingly and illegally employ minors may face penalties, such as double compensation, under state WC laws if these minors are injured at work

minor (child) - legally employed

WC functions the same for legally employed minors as it does for those that have reached the age of majority

minimum retrospective premium

In a retrospective rating plan, the lowest premium amount the policyholder can pay under the plan, regardless of incurred losses

modified duty / modified work

work, other than usual and customary employment, that falls within certain physical restrictions prescribed by an injured worker’s medical provider; part of an employer’s return to work program

modified premium

premium calculation after application of an experience modification factor (similar to standard premium, but does not reflect any schedule credits or debits)

modified standard premium

the estimated premium shown on the information page; considered the “front-end cost” on WC policies

modifier

see experience modification factor

Monday morning syndrome

for WC, the tendency of some workers to fraudulently report that they were injured on Monday at work when the injury actually occurred as a result of weekend, non-work activities

monopolistic state fund

state-operated WC insurer in some states that require that all businesses other than those permissibly self-insured buy WC from the state – private insurers cannot compete in these states (the monopolistic states are ND, OH, WA, and WY-- WV began to allow  private WC insurance in July 2008)

multiple injury trust fund

same as subsequent injury fund

mutual insurer

insurance company owned by its policyholders (by contrast, a stock insurer is owned by its shareholders)