Worker’s Compensation Terms To Know
Average Daily Wage (ADW)
Average daily earnings of an employee before an injury. Use to calculate benefits payments in situations where AWW would not provide an accurate reflection of actual wages.
Average Weekly Wage (AWW)
Average weekly earnings of an employee before an injury, which is used as a basis for determining weekly benefits payments.
Final premium for the policy term based on actual payroll exposures.
Date of Injury (DOI)
Date when injury or illness occurred or, in the case of repetitive exposure injuries or illness, when it first became apparent that symptoms were work related.
Benefits paid to surviving dependents when an employee dies as a result of injury or illness caused by their employment.
Experience Modification Factor
An adjustment to the Manual Premium, calculated by an advisory organization (also known as rating bureaus), such as NCCI. It’s based on historic loss and payroll data of a particular insured. Also know as Experience Modifier, or Experience Mod.
Independent Medical Examination (IME)
Requested by an employer or insurer to serve as an objective evaluation of an injured employee’s condition. IMEs are used in situation where the findings of an employee’s self-selected doctor need to be verified.
Temporary work restrictions placed on an injured employee by their physician that allows the employee to return to work while also allowing for their injury to heal properly.
Lump Sum Payment
The award of workers’ compensation benefits in one or more partial or total payments, instead of in weekly or biweekly payouts.
Workers’ compensation premium calculated through a combination of the employer’s payroll and the insurer’s premium rates.
Maximum Medical Improvement (MMI)
Point in an injured employee’s treatment when recovery has reached a plateau with no reasonable expectation of continued improvement.
Workers’ compensation premium after the application of an experience modification factor. Does not reflect any schedule credits or debits.
Illness or disease primarily caused by exposures faced by an employee in their work environment over the course of their employment.
Any injury, illness or death that results from a work-related event or from repetitive trauma or other repetitive acts required of an employee over the course of their employment.
Permanent Partial Disability (PPD)
Benefits paid to an employee who has suffered compensable work-related injury or illness to one or more parts of the body. Most states have a preset payment schedule (Schedule of Injuries) based on specific body parts or conditions.
Permanent Total Disability (PTD)
Benefits paid to employees who face lifelong total disability from compensable work-related injury or illness.
Certain states require employers to notify their employees of their workers’ compensation rights.
Primary/Excess Split Point
The dollar value that splits a loss into its primary cost and excess portions. Currently, the first $5,000 of a loss is considered the primary cost and the portion above $5,000 is considered excess. Effective Jan. 1, 2013, the primary/excess split point will be inflation-adjusted to $15,000 over a three-year transition period to better correlate with claim inflation, which affects the experience rating plan.
The first $5,000 of any single loss in the experience modification factor.
A premium credit, based on the size of the premium that is paid.
Schedule of Injuries
List of payment amounts and maximum number of weeks PPD benefits are to be paid based on the part of the body that was injured.
Social Security Disability Benefits (SSDI)
Benefits paid to disabled individuals through the Social Security Administration, separate from workers’ compensation. Most state workers’ compensation statutes regulate whether an individual can receive both benefits at the same time. If both benefits are awarded, there are limits in place to ensure that an individual cannot receive more money than they are entitled to from either program independently.
Premium after application of experience modification factor and schedule credits and/or debits, but before premium discount.
Statewide Average Weekly Wage (SAWW)
Average wages paid to workers in a set jurisdiction for a period of time, used to set the maximum and minimum for workers’ compensation benefits paid out to injured workers.
Temporary Partial Disability (TPD)
Benefits paid to an injured worker who is temporarily unable to fulfill the full requirements of their job but is able to perform at a reduced level. Benefits paid in such instances are based on possible pay differences between the regular and temporary position.
Temporary Total Disability (TTD)
Benefits paid to employees who are totally unable to work for a period of time but will make a full recovery. Though TTD payments stop when the employee is cleared to return to work, they may be eligible for TPD benefits if they still face some work restrictions.
Any of a number of services offered to injured employees to help them return to the workforce in a new occupation if they have suffered disabilities that will not allow them to return to their initial occupations.