Term

Definition

safety committee

a group within an employer, typically including both labor and management, that meets regularly and discusses ways to reduce WC losses

safety group plan

WC insurance plan where similar employers work together to reduce injuries, sharing any premium dividends

schedule credit/debit

discretionary premium adjustment based on the underwriter's evaluation of special characteristics of the employer not reflected in the experience modification factor

schedule of impairments

same as schedule of injuries

schedule of injuries

list in many state WC statutes providing the maximum number of weeks of permanent partial disability benefits for selected body parts

schedule rating

application of debits or credits to premium to adjust the premium for various positive or negative risk factors

scheduled benefit, scheduled loss

for WC, a permanent partial disability for which the permanent disability payment is specified in a schedule in the state WC statutes

Scopes Manual

NCCI manual that indicates what kinds of workplace exposures belong in particular WC classification codes

seaman

person (man or woman) eligible for Jones Act benefits; must have a substantial connection to the vessel and its purpose

second injury fund (SIF)

older term for subsequent injury fund

secondary classification

classification code other than the governing classification

self-employed

employment status that normally does not require the purchase of WC coverage

self-inflicted injury

for WC, a self-inflicted injury to the worker that creates a compensability issue

self-insurance / self-insurer

WC program where the employer pays WC benefits directly instead of purchasing WC coverage; employers have to have the WC regulator’s permission to self-insure and have to purchase an excess WC policy; as of March 2005, WC self-insurance is allowed in all states except ND and WY

self-insurance group

group of similar employers that the state allows to become a single qualified self-insurer

self-insured retention

for excess WC policies, the maximum dollar amount per occurrence that the policyholder would have to pay itself

self-insured trust

same as self-insurance group

short-rate cancellation

situation where the employer cancels its WC policy early in the covered time period; the insurer can often charge some type of penalty

short-term disability coverage

wage replacement insurance, provided by a mandatory state program in a few cases, to pay for disabilities not covered by WC; typically limited to 26 weeks of benefits or less

signed statement

unedited written narrative from an injured worker, employer, or witness to an accident or injury

sliding scale dividend

refund of premium, after policy expiration, based on the favorable loss experience of the individual employer

small deductible plan

plan allowed in some states where employers reimburse the insurer between $500-$5000 per claim, sometimes reducing their overall WC costs

social activities

company-connected social activities occurring off-premises or after-hours may be not covered by WC

Social Security disability income benefits (SSDI)

SSDI benefits are paid to disabled individuals by the federal Social Security Administration -- most state WC statutes require coordination of SSDI with WC, resulting in either an offset or reverse offset of WC benefits

Social Security offset

in some states, Social Security benefits are reduced by the amount of WC benefits being received

soft market

insurance market conditions generally characterized by inadequate premium to risk, broadened scope of coverage, and many insurers willing to write coverage (opposite of hard market)

sole proprietor

the only owner of a business that has not organized as a corporation or limited liability company (LLC) - a sole proprietor is not automatically eligible for WC benefits

Sole Proprietors, Partners, Officers and Others Coverage Endorsement

endorsement extending WC coverage to sole proprietors, partners and officers in states where they have a choice to be covered by WC or not

special employer

an alternate employer

special errand rule

for WC, a trip where the worker performs both non-work duties and duties for the benefit of the employer (e.g., an employee who makes a bank deposit for the employer on her way home) – same as dual-purpose trip

special funds

subsequent injury funds and other funds administered by states to pay or reimburse benefits where it seems unfair for the employer or insurer to bear the full cost of them

specific excess insurance

insurance that limits the policyholder’s exposure from any one occurrence to a predetermined level

spendable earnings

in a most states, the weekly wage replacement payment rate is based on a percentage of gross wages, but in a few states it is based on a higher percentage of the after-tax income (spendable earnings) of the worker

spoliation

failure to retain, or the destruction of, physical evidence needed to resolve a legal matter

spouse

for WC, a husband, a wife, or, in a state where domestic partners have the same rights as husbands and wives, a domestic partner

SROI

abbreviation for Subsequent Report of Injury; for WC, this abbreviation is typically used in conjunction with EDI requirements

standard dividend plan

WC premium plan where an employer with favorable loss experience can receive a partial refund of the premium

standard exception classification

for premium calculation, classifications which are normally not included in the governing classification – these include clerical, outside sales, and often (but not always) drivers

standard premium

premium after applying an experience modifier and schedule credit or debit, but before premium discount

standard workers compensation insurance policy

published by the National Council on Compensation Insurance (NCCI), this same policy is used for almost all private WC insurance

state fund

see competitive state fund or monopolistic state fund

statement

unedited narrative from an injured worker, employer, or witness to an accident or injury, captured in written form (signed statement) or on recorded media (recorded statement)

statewide average weekly wage (SAWW)

computation of average wages paid to workers during a set time period, used in some states as a factor in setting the minimum compensation rate and maximum compensation rate

statistical plan manual

see unit statistical report

statutory employee

injured worker who qualifies as an employee under the WC statutes solely because of provisions in some WC statutes requiring the employer to provide WC (e.g., employee of an uninsured subcontractor)

statutory presumption

a condition presumed correct by WC statutes, generally subject to rebuttal by credible evidence (a presumption shifts the normal burden of proof)

stay at work

WC concept that says it is better for both the injured worker and the employer if work can be modified during the recovery period so that the worker continues to report to work and do work within doctor-agreed physical restrictions

stipulated agreement (stip)

formal agreement to resolve a portion of a WC claim

stipulation (stip)

same as stipulated agreement

stop loss insurance

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

stopgap coverage

employers liability coverage endorsement to a general liability policy; used only in monopolistic states where the employer has no WC policy containing Part Two employer's liability coverage; called "stopgap" because it eliminates the EL coverage gap

street risk

for WC, a level of risk in the workplace that is no greater than that outside of the work location – in increased risk doctrine states, street risk is a compensability issue; in positional risk doctrine states, it is not

structured settlement

settlement technique that involves the use of an annuity to provide a stream of benefits over time

sub rosa investigation

older term for surveillance

subcontractor

any business while performing work under the direction of a general contractor (often seen in construction projects)

subject losses

for retrospective rating, policyholder’s actual losses subject to the loss limitation or retrospective rating plan limits

subject premium

same as standard premium

subrogation

for WC, the right of a WC payer to "stand in the shoes of" the injured worker and recover from a legally responsible entity (third party) the WC benefits it paid

subscriber

in monopolistic WC states, an employer that purchases coverage from the state or state WC fund

subsequent injury fund relief (SIF)

state agencies established to encourage employers to hire workers with preexisting disabilities – the most traditional use of SIF is to cover the increase in the cost of a WC injury as a result of that pre-existing disability (many states have discontinued their SIF programs)

successive injury fund

less common term for subsequent injury fund

suicide

most suicides are not compensable but some have been ruled compensable

surcharge

a residual market plan often contains a surcharge for its employers

surveillance

secret investigation of an injured worker's activities to determine whether they exceed stated work restrictions

survivors' benefits

same as death benefits