These simplified explanations are for educational purposes. They are NOT precise legal definitions.

Phrases italicized below are defined in this glossary.

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
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 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 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 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
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)
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, WV, and WY-- WV will start to allow private WC insurance in July 2008)
mutual insurer	insurance company owned by its policyholders (by contrast, a stock insurer is owned by its shareholders)

Copyright 2004-2008 Gary Hinson. All Rights Reserved.

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