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Term
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Definition
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safety group plan
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WC insurance plan where similar employers work together to reduce injuries, sharing any premium dividends
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schedule credit/debit
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discretionary premium adjustment based on the underwriter's evaluation of special characteristics of the employer not reflected in the experience modification factor
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schedule of injuries
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list in many state WC statutes providing the maximum number of weeks of permanent partial disability benefits for selected body parts
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schedule rating
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application of debits or credits to premium to adjust the premium for various positive or negative risk factors
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scheduled benefit
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for WC, a permanent partial disability for which the permanent disability payment is specified in a schedule in the state WC statutes
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Scopes Manual
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NCCI manual that indicates what kinds of workplace exposures belong in particular WC classification codes
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seaman
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person (man or woman) eligible for Jones Act benefits; must have a substantial connection to the vessel and its purpose
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second injury fund (SIF)
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older term for subsequent injury fund
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secondary classification
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classification code other than the governing classification
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self-inflicted injury
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for WC, a self-inflicted injury to the worker that creates a compensability issue
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self-insurance / self-insurer
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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
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self-insurance group
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group of similar employers that the state allows to become a single qualified self-insurer
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self-insured retention
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for excess WC policies, the maximum dollar amount per occurrence that the policyholder would have to pay itself
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self-insured trust
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same as self-insurance group
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short-rate cancellation
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situation where the employer cancels its WC policy early in the covered time period; the insurer can often charge some type of penalty
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short-term disability coverage
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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
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signed statement
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unedited written narrative from an injured worker, employer, or witness to an accident or injury
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sliding scale dividend
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refund of premium, after policy expiration, based on the favorable loss experience of the individual employer
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Social Security disability income benefits (SSDI)
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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
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soft market
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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)
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sole proprietor
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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
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Sole Proprietors, Partners, Officers and Others Coverage Endorsement
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endorsement extending WC coverage to sole proprietors, partners and officers in states where they have a choice to be covered by WC or not
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special employer
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an alternate employer
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special errand rule
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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
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specific excess insurance
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insurance that limits the policyholder’s exposure from any one occurrence to a predetermined level
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spoliation
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failure to retain, or the destruction of, physical evidence needed to resolve a legal matter
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spouse
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for WC, a husband, a wife, or, in a state where domestic partners have the same rights as husbands and wives, a domestic partner
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standard dividend plan
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WC premium plan where an employer with favorable loss experience can receive a partial refund of the premium
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standard exception classification
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for premium calculation, classifications which are normally not included in the governing classification – these include clerical, outside sales, and often (but not always) drivers
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standard premium
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premium after applying an experience modifier and schedule credit or debit, but before premium discount
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standard workers compensation insurance policy
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published by the National Council on Compensation Insurance (NCCI), this same policy is used for almost all private WC insurance
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state fund
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see competitive state fund
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statement
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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)
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statewide average weekly wage (SAWW)
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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
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statistical plan manual
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see unit statistical report
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statutory employee
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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)
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statutory presumption
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a condition presumed correct by WC statutes, generally subject to rebuttal by credible evidence (a presumption shifts the normal burden of proof)
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stipulated agreement (stip)
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formal agreement to resolve a portion of a WC claim
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stipulation (stip)
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same as stipulated agreement
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stop loss insurance
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for self-insurers, a way to limit claim costs above a specific amount
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stopgap coverage
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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
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street risk
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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
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structured settlement
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settlement technique that involves the use of an annuity to provide a stream of benefits over time
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sub rosa investigation
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older term for surveillance
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subcontractor
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any business while performing work under the direction of a general contractor (often seen in construction projects)
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subject losses
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for retrospective rating, policyholder’s actual losses subject to the loss limitation or retrospective rating plan limits
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subject premium
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same as standard premium
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subrogation
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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
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subscriber
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in monopolistic WC states, an employer that purchases coverage from the state or state WC fund
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subsequent injury fund relief (SIF)
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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)
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successive injury fund
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less common term for subsequent injury fund
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surcharge
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a residual market plan often contains a surcharge for its employers
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surveillance
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secret investigation of an injured worker's activities to determine whether they exceed stated work restrictions
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survivors' benefits
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same as death benefits
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