Term

Definition

unallocated loss adjustment expense (ULAE)

those claim-handling expenses of the insurer that are not easily attributed to any single claim; in retrospective rated plans, these expenses are part of the loss conversion factor

unbundled services

insurance arrangement where, at the request of the policyholder, an entity other than the insurer (often a TPA) handles claim administration or some portion of it; loss control services are also sometimes unbundled

unbundling (medical)

charging separately for medical services that should be grouped

underwriting cycle

theory that U.S. property and casualty insurers conduct business in a never-ending cycle of hard markets and soft markets

underwriting department

insurer’s unit responsible for determining whether to offer WC insurance to an employer and at what premium

uninsured employer funds

some states have funds that pay benefits to injured workers when their employers fail to obtain WC insurance

unit statistical report (unit stat report)

calculation of premium and losses the insurer files with regulators; the calculation methods are governed by a statistical plan manual such as that of NCCI

United States Longshore and Harbor Workers Compensation Act (USL&H)

see Longshoremen's and Harbor Workers Compensation Act

unity modification

an experience modification factor of 1.0, resulting in no credit or debit to premium

upcoding

for WC, assigning a different CPT code to increase the rate of reimbursement

usual and customary employment

the set of job duties that the injured worker typically performed prior to the work injury

usual exertion doctrine

for some injuries to be covered by WC, the physical exertion must be unusual (often considered in heart attack claims)

utilization review

for WC, prospective, concurrent, or retrospective review of the effectiveness of medical services