Glossary
801
The Report of Occupational Injury or Disease, informally known as an "801" or "injury report." Employers are responsible for sending this form to their insurance carriers (or, if self-insured, to their claims administrator), within five days of their knowledge of a claim to notify their carrier of a job-related injury. SAIF also has an 801S claim form, which is designed to help your Spanish-speaking employees communicate the details of their injury to us. The injured worker can complete the top portion of the form in Spanish.
827
The first medical report that physicians send to insurance carriers or self-insured employers within 72 hours of their first treatment of an injured worker. This form is also used to report an aggravation, a change of attending physician, a progress report, or a closing report.
A
ADA - Americans with Disabilities Act
ANP - Authorized nurse practitioner
AWW - Average weekly wage
Acceptance of a claim
When an injured worker's claim is received, a certified claims examiner working for the employer's insurance company determines if the worker's injury or disease qualifies for benefits based on Oregon Revised Statutes and Oregon Workers' Compensation case law. (See Compensability.) The decision to accept or deny a claim must be made within 60 days of the employer's notice or knowledge of an occupational injury or disease.
Adjuster
A person trained and certified in processing and managing claims. Often referred to as a "claims adjuster" or "claims examiner."
Administrative Law Judge
A person appointed by the Workers' Compensation Board to adjudicate disputes between workers, employers, and insurers.
Aggravation
A claim made by or on behalf of an injured worker requesting additional compensation and medical treatment for a compensable condition that has worsened since the worker's claim was closed. A worsened condition resulting from the original injury is established by medical evidence supported by objective findings. The worsened condition is not compensable if the major contributing cause is an injury that occurred outside the course and scope of employment.
Appeals
Nearly every decision in the life of a workers' compensation claim can be appealed. The process usually begins with a Request for Hearing filed by the worker or representative of the worker (usually an attorney) with the Workers' Compensation Board (WCB). (See Workers' Compensation Board.) The appeal is assigned to an administrative law judge who presides over a hearing. The administrative law judge's decision can be appealed to the WCB. Any action the WCB takes can be appealed to the state appellate court system. Appeals of medical or vocational issues are decided by the director of the Oregon Department of Consumer and Business Services.
Assigned risk pool
Properly known as the Oregon Workers' Compensation Insurance Plan, the assigned risk pool was established in 1980 to provide a guaranteed source of coverage for employers required by law to have workers' compensation insurance but who are unable to obtain it in the voluntary market. The policies of businesses insured through the pool are assigned to one of two insurance carriers designated to service assigned risk policies. Losses experienced by businesses in the pool are apportioned to all insurance carriers in the state based on market share. Employers in the pool may fall into two categories: those that are hard to insure because of size and those considered poor risks due to high claims frequency, poor safety practices, or bad credit ratings.
Attending physician
An attending physician in workers' compensation cases is defined as a doctor who is primarily responsible for the treatment of a worker's compensable injury or illness. An attending physician must be:
- A medical doctor or doctor of osteopathy licensed by the Board of Medical Examiners for the State of Oregon or an oral and maxillofacial surgeon licensed by the Oregon Board of Dentistry, or a similarly licensed doctor in any country or in any state, territory, or possession of the United States; or
- For a cumulative total of 60 days from the first visit on the initial claim or for a cumulative total of 18 visits, whichever comes first, to any of these medical service providers:
- A doctor or physician licensed by the State Board of Chiropractic Examiners for the State of Oregon or a similarly licensed doctor or physician in any country or in any state, territory, or possession of the U.S., or
- A podiatric physician and surgeon licensed by the Board of Medical Examiners for the State of Oregon or a similarly licensed physician in any country or in any state, territory, or possession of the U.S., or
- A physician assistant licensed by the Board of Medical Examiners for the State of Oregon or a similarly licensed physician assistant in any country or in any state, territory, or possession of the U.S., or
- A doctor of naturopathy or naturopathic physician licensed by the Board of Naturopathic Examiners or a similarly licensed doctor or physician in any country or in any state, territory, or possession of the U.S.
Except as otherwise provided for workers subject to a managed care contract, "attending physician" does not include a physician who provides care in a hospital emergency room and refers the injured worker to a primary care physician for follow-up care and treatment.
Audit
An examination with intent to verify information.
Average weekly wage
The average weekly wage is determined by the Oregon Employment Department for all workers in Oregon and is used to establish maximum benefits that an injured worker can receive in compensation (time loss). It is also used to determine permanent total disability and death benefits payment amounts. An average weekly wage also may refer to the injured worker's wage at the time of injury.
Award
An award is compensation determined by the insurer and paid to injured workers or dependents for permanent disability resulting from occupational injury, disease or death. Permanent Partial Disability awards (see Permanent Partial Disability) are paid either in a lump sum or in monthly payments to an injured worker or the worker's beneficiaries until the full amount awarded for the disability award is paid. Permanent Total Disability awards (see Permanent Total Disability) are paid for the life time of the worker.
B
BBP - Blood borne pathogen
BOLI - Bureau of Labor and Industries
Basic premium
The portion of premium which covers the expenses associated with providing insurance services (as opposed to those associated with paying claims).
Beneficiary
An injured worker's spouse or registered domestic partner, child, or dependent entitled to receive payments under the workers' compensation law.
Benefits
Time loss or compensation, medical expenses, expenses for return to work, and other services provided to an injured worker by law as result of a compensable injury.
C
CDA - Claims Disposition Agreement
CTD - Cumulative Trauma Disorder
CTS - Carpal Tunnel Syndrome
Carrier
An insurance company that provides insurance coverage. When discussing workers' compensation insurance in Oregon, "carrier" can refer to a private insurance company or SAIF Corporation, which is a not-for-profit, state-chartered workers' compensation company.
Casualty insurance
Those lines of insurance primarily concerned with losses caused by injuries or damages to a person or property and the legal liability caused by such injuries.
Catastrophe
In workers' compensation insurance, any situation resulting in hospitalization of three or more workers or the death of two or more workers in the same incident is considered a "catastrophe."
Certificate of coverage
A certificate issued by an insurance company to employers who have current insurance coverage, or to individuals or companies that contract with the employers.
Claim
A written request for compensation from a worker or someone on the worker's behalf, or any compensable injury of which the employer has notice or knowledge.
Claimant (injured worker)
A person who files a claim for financial losses covered by an insurance agreement. In Oregon, an injured worker makes a claim for compensation with the employer's insurance carrier or directly to the administrator of self-insured programs.
Claim frequency rate
The number of claims per unit of exposure for a period of time.
Claim reserves
In an accounting or financial reporting context, reserves are premium and investment income kept in "reserve" to cover claim costs already incurred but not yet paid or anticipated future claims costs.
Classification (Class)
Two definitions:
1) A grouping of occupations having similar working conditions and hazards. Payroll and loss records for these groups are used to establish rates. The National Council on Compensation Insurance (NCCI) uses this data to determine "pure premium" rates for these classes -- i.e. the "break even" rate needed to cover claim costs estimated for each class.
2) The payroll classification(s) assigned to a firm based on the types of work its employees perform.
Closed claim
This term is used to describe a point in time that the worker is medically stationary for establishing when time loss should terminate and any permanent disability should be determined.
Compensability
The process by which a claims adjuster evaluates the worker's claim and decides if the injury or disease is work-related and acceptable as a workers' compensation claim.
Compensable injury
An accidental injury to person or prosthetic device, arising out of and in the course of employment which requires medical services or results in disability or death; the result is an accident whether or not due to accidental means. A compensable injury must be established by medical evidence supported by objective findings.
Compensation
All benefits, including medical services, provided for a compensable injury or disease to a worker or worker's beneficiaries by an insurer or self-insured employer pursuant to Oregon law.
Compliance section
A regulatory division of the Workers' Compensation Division which administers the filing and processing of workers' compensation claims. It also enforces the requirement that all subject employers have workers' compensation insurance.
Claims Disposition Agreement (CDA)
A process that permits an insurance company and an injured worker or the worker's representative to negotiate a lump-sum settlement of an accepted work-related injury or disease claim in lieu of potential future compensation. Medical benefits can not be negotiated as part of a claims disposition agreement.
Course and scope
The Oregon Workers' Compensation system uses a "unitary" approach to determining compensability of a claim. Thus, a claim occurs "in course of employment" when the worker is actually performing activities associated or incidental to work responsibilities. A claim may also "arise out of employment," meaning that the injury or disease must be attributable to the hazards of the employment. In Oregon, these two concepts are merged to form one of the tests for claim acceptance or denial.
Coverage
The scope of the protection provided under a contract of insurance.
D
DC - Chiropractor
DCBS - Department Of Consumer and Business Services
DCS - Disputed Claim Settlement
DDS or DMD - Dentist/Oral Surgeon
DMV - Department of Motor Vehicles
DOA - Date of accident
DOE - Department of Employment
DOI - Date of injury
DOK - Date of knowledge
DTEC - Domestic Terrorism, Earthquakes, and Catastrophic Accidents
DCBS
Abbreviation for the Department of Consumer and Business Services which administers the Workers' Compensation Division (WCD).
Death claim
A claim for benefits made by a potential beneficiary of a worker whose death resulted from a work-related injury or occupational disease.
Deferred
The status a claim is placed in while it is being evaluated for acceptance or denial. During this time the insurer gathers information regarding the claim's compensability. (See Compensability.) The law allows an insurer up to 60 days from the date the worker's employer knew about the injury or disease to make this determination.
Denial
Written letter to an injured worker informing him/her that the claim for benefits is not compensable according to workers' compensation statutes and case law.
Developed losses
As time passes after a claim is filed, more accurate information on actual medical costs and time-loss benefits becomes available. Losses are then considered to be more "developed." Paid losses and reserves are used in determining developed losses.
Disabling compensable injury
An injury or occupational disease is disabling when, in addition to medical services, temporary disability benefits are due or there is a reasonable expectation that permanent disability will result from the injury or occupational disease.
Disabling injury
A job-related injury which entitles a worker with temporary or permanent disabilities to workers' compensation benefits.
Disputed claim settlement (DCS)
An agreement between an insurance carrier and an injured worker, approved by a Workers' Compensation Board administrative law judge, to settle a dispute over the compensability of a claim. This type of agreement only is used when a dispute reamins as to the compensability of the claim.
Domestic Terrorism and Catastrophes (DTEC)
A hazardous exposure identified by the National Council on Compensation Insurance (NCCI) that has not been included in the rate-making process. NCCI developed a premium charge, approved by the Oregon Insurance Commissioner effective January 1, 2005, to cover this exposure. DTEC exposures include acts of domestic terrorism (outside the scope of Foreign Terrorism), earthquakes, and catastrophic industrial accidents.
E
EAIP - Employer-at-Injury Program
ELCB - Employers Liability Coverage Benefits
ER - Experience Rating
Earned premium
The standard premium less the discount allowed by SAIF's premium discount percentages. (See Standard Premium and Premium Discount.)
Effective date
The date and hour according to policy contract in which a policy or endorsement becomes effective, providing insurance protection.
Employer's liability law
The law setting forth conditions and extent of liability of employers to their employees for injury, illness, or death arising out of and in the course of their employment and which are not covered under workers' compensation law.
Estimated payroll
Payroll estimated by month or quarter when employers fail to report actual payroll. Used as a basis for determining the premium an employer pays.
Expected losses
The National Council on Compensation Insurance (NCCI) publishes an expected loss rate for each class, based on past claims experience for these classes. It then computes an employer's expected losses by multiplying payroll, class by class, by the expected loss rate for each class.
Expense constant
A flat charge insurance carriers require for each policy period or fraction of a period to offset fixed expenses such as policy issuance, data processing, auditing and general statistical and coverage record systems. This fee is not a function of the size of the account. Sometimes referred to as a renewal fee. (See Renewal Fee.)
Experience rating analysis
A mathematical formula that fosters fair insurance pricing by tailoring premium to an insured's actual experience. The formula is used to develop a firm's Experience Rating Modification ("ER Mod") figure, which reflects the firm's true loss experience. The form used to calculate this is called the Experience Rating Analysis Form.
Experience rating modification
A percentage figure, also called an "ER Mod" or "Mod," applied to the manual premium to reflect an insured's actual loss experience. The ER Mod can increase or decrease premium, based on the employer's past claims history. Firms with an ER Mod of less than 100 (the average for their type of industry) are rewarded by paying reduced premiums. Firms with ratings above 100 bear a portion of their higher claims costs by paying increased premiums.
F
FID - Fraud and Investigations Division
FTP - Foreign Terrorism Premium
Fatality
An accidental injury or disease resulting in death of an Oregon subject worker. Benefits are provided to eligible beneficiaries.
Federal claims
Workers' compensation claims processed under federal (rather than state) law. Major federal laws are the Longshore and Harbor Workers' Compensation Act, the Federal Employers' Liability Act, and the Jones Act. Other federal laws under which insurance carriers process claims include: the Nonappropriated Fund Instrumentalities Act, Defense Base Act, and the Outer Continental Shelf Lands Act.
Final audit - physical
Shows the premium impact following the completion of a payroll records review by SAIF.
Final audit - reconciliation
Shows the premium impact summarized at the end of the policy period for policies completing two or more premium reports or policies in combination.
Final audit - voluntary
Shows the premium impact after filing the policy period payroll report on installment & annual pre-pay accounts.
Foreign terrorism premium (FTP)
Foreign Terrorism is a hazardous exposure that was unfunded prior to Congress enacting the Terrorism Risk Insurance Act (TRIA) on November 26, 2002. At that time, the National Council on Compensation Insurance (NCCI) developed a premium charge, approved by the Oregon Insurance Commissioner, to cover this exposure. The term "Foreign Terrorism Premium" replaces "TRIA" in policy documents.
Frequency rate
Number of claims per $100,000 payroll
Full denial
A legal action taken by workers' compensation carriers to deny any and all compensability for a worker's compensation claim.
H
Hearings division
The division of the Workers' Compensation Board that administers the hearings process and insurers in a semi-formal legal proceeding.
I
IH - Industrial Hygiene
IME - Independent medical examination
IW - Injured worker
Incurred loss
The total dollars paid for a claim plus outstanding reserves.
Industrial Accident Section, Department of Justice
A section of the General Counsel Division of the Department of Justice which includes the assistant attorneys general assigned as counsel to SAIF Corporation.
Industrial hygiene
The science devoted to the recognition, evaluation, and control of environmental factors, elements, and stresses in the workplace, which may cause sickness or impair health or productivity of employees.
Injured worker
A person who files a claim for benefits covered by an insurance agreement. In Oregon, an injured worker makes a claim for compensation through the employer's insurance carrier or directly to the administrator of self-insured programs.
Injury report
A report showing information (such as description of the accident, injured worker's name, age, and occupation, etc.) for all claims filed by a firm for a specified time period. It is used to determine recommendations regarding safety or loss control programs, as well as to explain claim costs (paid and reserved) to employers.
Insurance Commissioner
The state official responsible for regulating insurance companies within Oregon. Insurance carriers file their rates with this commissioner, who also reviews financial statements to make sure carriers are operating with sound insurance practices. The Insurance Commissioner is also director of the Department of Consumer and Business Services and is appointed by the governor.
Insured
An employer who has workers' compensation coverage.
L
Loss ratio
A figure determined by dividing losses by premium. The loss ratio usually applies to a one-year period and is expressed as a percentage. Loss ratios can be expressed in terms of paid losses to standard premium or incurred losses to earned premium.
Lump sum payment
Payment of the Permanent Partial Disability (PPD) award in one installment. Awards less than $6,000.00 are paid to injured workers in one installment. Larger awards are paid to injured workers in monthly installments; however, the worker can petition the insurer to pay the entire award in one payment. To make a lump sum payment on amounts exceeding $6,000.00, approval is required from the insurer.
M
MD - Medical Doctor
MCO - Managed Care Organization
MO - Medical only or non-disabling claim
MARS - Medical Audit Review Section
MOD(S) - Insurance premium modification
MRI - Magnetic Resonance Imaging
MRU - Medical Review Unit at DCBS
MS - Medically stationary
Managed care organization (MCO)
A group of medical care providers who obtain certification from the Department of Consumer and Business Services and contract with an insurance carrier to provide medical care to the injured workers of the carrier's policyholders.
Manual premium
Payroll by class multiplied by the insurer's approved rates. Manual premium does not include application of the experience rating modification or premium discounts. (See Experience Rating Modification and Premium Discount.)
Medical arbiters
A physician or panel of physicians appointed by the director of the Department of Consumer and Business Services to examine an injured worker to assist in the resolution of disputes over medical treatment or the extent of permanent impairment.
Medical fee schedule
A schedule published by the director of the Workers' Compensation Division which outlines maximum fees medical providers may be paid for treating Oregon industrial injuries.
Medical only
A claim without time loss or a permanent disability that requires medical treatment only. Also called a "nondisabling injury."
Medically stationary
The status of a worker when no further material improvement can be expected from further medical treatment or the passage of time.
Minimum premium
The lowest amount of premium for which an insurer will issue coverage for a given policy period. At SAIF, the minimum premium includes the expense constant. (See Expense Constant.)
Modified work
See "Transitional work"
N
NCE - Non-complying employer; employer without workers' compensation coverage
NCCI - National Council on Compensation Insurance
ND - Naturopathic physician
NDR - Nondisabling Claim Reimbursement
NOC - Notice of Closure (Insurer Closure)
NP - You may also see the abbreviations ANP (authorized nurse practitioner) or FNP (family nurse practitioner)
National Council on Compensation Insurance (NCCI)
A national rate-making organization for workers' compensation insurance serving Oregon and 38 other states. The policies established by NCCI are governed by its members, which include private carriers, self-insureds and state funds involved in workers' compensation insurance.
Non-complying employer
An employer who fails to provide required workers' compensation coverage as required for employees or defaults on coverage.
Nondisabling compensable injury
Any injury or occupational disease which requires medical services only.
Non-renewal
A firm that does not have its insurance policy renewed by its carrier because of adverse loss experience, credit problems, or because it falls into a category of business that is hard to insure because of its size.
Non-subject worker
An employee for whom workers' compensation coverage is not required by law. See ORS 656.027 for a listing.
Notice of Closure
An order issued by an insurer or self-insured employer following a closing evaluation to determine the permanent partial disability findings used to rate permanent partial disability for the injured worker. The claim closure occurs after the insurer receives written notice from the attending physician documenting that the worker is medically stationary (see Medically stationary) and describing any permanent impairment findings. The order normally establishes the degree of permanent partial disability (see Permanent partial disability) and the time period during which temporary total disability (see Temporary total disability) or temporary partial disability (see Temporary Partial Disability) payments should have been paid to the injured worker.
O
OCCPAP - Oregon Contractors Classification Premium Adjustment Program
OAR - Oregon Administrative Rule
OD - Occupational disease
ODL - Oregon driver's license
OGSERP - Oregon Group Supplemental Experience Rating Program
OJT - On-the-job training
OM - Own motion
ORS - Oregon Revised Statute
OSHA - Occupational Safety and Health Administration
Objective findings
Used in determining whether a claim meets the statutory definition of a compensable condition. It includes, but is not limited to, range of motion, atrophy, muscle strength, muscle spasm, and diagnostic evidence substantiated by clinical findings.
Occupational disease
Any disease or infection which arises out of and in the course of employment to which the employee is not ordinarily subjected or exposed other than during the period of regular, active employment (e.g. repeated exposure to toxic chemicals that cause respiratory problems). The worker must prove that employment conditions were the major contributing cause (more than 50 percent) of the disease or its worsening. Existence of the disease or worsening of a pre-existing disease must be established by medical evidence supported by objective findings.
Occupational Safety and Health Administration (OSHA)
Agency created by the federal Department of Labor, as a result of the OSHA Act of 1970, to administer and enforce safety and health standards.
Opinion and order
Legal document from the Workers' Compensation Board Hearings Division providing a ruling on a litigated issue(s) before an administrative law judge.
Oregon Occupational Safety and Health Division (OR-OSHA)
A division of the Department of Consumer and Business Services that sets and enforces safety and health regulations for Oregon employers. OR-OSHA administers the Oregon Safe Employment Act (OSEA).
Own motion claim
The Workers' Compensation Board (WCB) has continuing jurisdiction over claims in which the aggravation rights have expired. The board may, on its own motion, modify, change, or terminate former findings, orders, or awards if in its opinion such action is justified. This term is frequently used when the WCB has ordered a claim reopened after the aggravation period has expired. May also be called "Board's own motion."
P
PA - Physician's assistant
PCP - Primary care physician
PE - Personal Election
PPD - Permanent partial disability
PPE - Personal Protective Equipment
PTD - Permanent total disability
PWP - Preferred Worker Program
Paid loss
The total dollars paid for a claim. Paid losses do not include outstanding reserves.
Palliative care
Medical services rendered to reduce or moderate temporarily the intensity of an otherwise stable condition. Palliative care is appropriate when a worker requires medical treatment to continue current employment or participation in a vocational training program. The worker's attending physician must request pre-approval for this treatment from the employer's insurance company. Palliative care does not include those medical services rendered to diagnose, heal, or permanently alleviate or eliminate a medical condition.
Partial denial
In major part, a denial of a specific condition or treatment in an accepted claim because it is not related to or caused by the accepted injury or occupational disease.
Paying agent
An insurer or self-insured employer appointed by the Workers' Compensation Division to be temporarily responsible for paying benefits due to an injured worker when several insurers and/or employers are involved in a dispute over which party is responsible for the worker's injury or disease. When the dispute is resolved by either legal order or stipulation, the insurer found responsible is obligated to reimburse the paying agent. This appointment occurs only if responsibility for the injury or disease is in dispute. A paying agent will not be named if compensability is also at issue. Generally, the insurer with the lowest compensation rate will be selected as the paying agent.
Payroll
A record of wages payable to workers for their services, including vacation pay, bonus pay, commissions, value of exchange labor, amounts paid under profit sharing agreements, and the reasonable value of board, rent, housing, lodging, or similar advantage received from the employer.
Payroll report
A form completed by the insured and given to the insurance carrier, covering a specified period and showing amounts of payroll paid to employees by classification.
Permanent partial disability (PPD)
When an injury results in a permanent - but not total - disability through the permanent loss of use or function or through the loss of future earning capacity.
Permanent total disability (PTD)
The loss of use or function of any portion of the body which permanently incapacitates the worker from regularly performing work at a gainful and suitable occupation. A suitable occupation is one that pays wages equal to 66 2/3 of the worker's weekly average wage or the federal poverty guidelines for a family of three, whichever is less, and which the worker has the ability, training, or experience to perform. Each claim where PTD has been awarded is re-examined by the insurer or self-insurer at least every two years from the date of the PTD order. This review can result in an affirmation of the previously awarded PTD benefits or a rescission of the PTD benefits.
Policy
The legal document that represents the coverage contract between an insurance carrier and an employer. It states rights, provisions and responsibilities of the two parties.
Policy period
The period of time between the effective and expiration dates of a policy.
Policyholder
Any person or business entity to whom a policy is issued.
Pre-existing condition
According to Oregon Revised Statutes, "preexisting condition" means, for all industrial injury claims, any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to disability or need for treatment, provided that:
- Except for claims in which a preexisting condition is arthritis or an arthritic condition, the worker has been diagnosed with such condition, or has obtained medical services for the symptoms of the condition regardless of diagnosis; and
- In claims for an initial injury or omitted condition, the diagnosis or treatment precedes the initial injury;
- In claims for a new medical condition, the diagnosis or treatment precedes the onset of the new medical condition; or
- In claims for a worsening pursuant to ORS 656.273 or 656.278, the diagnosis or treatment precedes the onset of the worsened condition.
- "Preexisting condition" means, for all occupational disease claims, any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to disability or need for treatment and that precedes the onset of the claimed occupational disease, or precedes a claim for worsening in such claims pursuant to ORS 656.273 or 656.278.
- For the purposes of industrial injury claims, a condition does not contribute to disability or need for treatment if the condition merely renders the worker more susceptible to the injury. (ORS 656.005)
Preferred worker
A worker who, because of a compensable injury, is unable to return to regular employment without substantial modifications to their work or work-site.
Preferred Worker Program
A program designed to encourage employers to hire injured workers that have a permanent disability who are unable to return to work without assistance. Self-insured employers or the insurance carriers of employers who hire "preferred workers" receive reimbursement from the Workers' Benefit Fund for claim costs of injuries incurred by these workers for three years from date of hire. In addition, the employer does not pay insurance premiums or premium assessments on the payroll of the preferred worker. This program is funded through the cents-per-hour assessment charged to employers and employees.
Premium
The cost of coverage. A premium is the rate per unit of coverage multiplied by the number of units of insurance purchased.
Premium audit
The review of the financial and payroll records of our policyholders to determine whether the payroll classification and levels of exposure within those classifications are properly reported to an insurance carrier.
Premium discount
A credit allowed to an insured based on premium volume which reflects the decrease in handling costs as the size of a risk increases.
Premium report
Shows the premium impact after submitting subject payroll for a specific reporting period.
Primary care physician
A physician qualified to be an attending physician (see Attending Physician) who is a general practitioner, family practitioner, or internal medicine practitioner. When an injured worker is subject to seeking care from a managed care organization (MCO), she can choose to treat with a primary care physician who does not belong to the MCO if the physician maintains the worker's medical records and has a documented history of prior treatment to the worker and agrees to abide by the terms and conditions of the MCO.
Private carrier
Any privately held insurance company offering workers' compensation coverage.
R
RN - Registered nurse
RR - Retroactive reserve
RSD - Reflex sympathetic dystrophy
RTW - Return to work
RX - Prescriptions
Rate
The cost of a specified unit of insurance coverage. For workers' compensation insurance coverage in Oregon, it is expressed as a charge per $100 of payroll, by industrial classification. The rate figure is based on past loss experience for each classification as compiled by the National Council on Compensation Insurance.
Reconsideration
A review proceeding conducted by the Appellate Unit of the Workers' Compensation Division at the request of the worker or insurer if either party is dissatisfied by a Notice of Closure. (See Notice of Closure.)
Regular work
The job the worker held at the time of injury or disease, or a job substantially similar in nature, duties, responsibilities, knowledge, skills, and abilities.
Reinstatement
The right of injured workers to return, following their recovery, to their original position with their employer at the time of their injury or disease or a suitable new position.
Renewal
The re-establishing of an insurance contract when the policy term is expiring.
Renewal fee
A flat charge insurance carriers require to renew coverage for each additional policy period. The fee is not a function of the size of the account and helps offset fixed expenses such as policy issuance, data processing, auditing, and general statistical and coverage record systems. Also called an expense constant. (See Expense Constant.)
Reserves
An amount intended to represent future probable liability. Carriers set funds aside to meet future time loss, medical expenses or awards for a claim. It's important that these funds be adequate because they are used in financial calculations, such as experience rating modifications for determining an employer's premium.
Return-to-work program
A program administered by insurance companies and/or employers to get injured workers back to work as soon as possible with duties approved by an attending physician.
S
SS - Social security
SSDI - Social security disability income
Safety committees
Committees of employer and employee representatives established to prevent job-related injuries or accidents. Oregon law requires safety committees for businesses with 11 or more employees and, under certain circumstances, for businesses with 10 or fewer employees and high losses or hazardous occupations.
SAIF Corporation
A not-for-profit, state-chartered workers' compensation company. "SAIF" stands for "State Accident Insurance Fund."
Scheduled disability
A permanent partial disability resulting from the permanent loss of use or function of body parts specifically listed in the Workers' Compensation Law. These parts are primarily the extremities of the body and loss of vision and hearing. For dates of inury before January 1, 2005.
Self-insurance
Under Oregon law, employers have three choices regarding workers' compensation insurance: insure with SAIF Corporation, insure with private carriers, or provide their own workers' compensation coverage. The last choice means they can "self-insure." In this case, employers establish a fund from which to pay benefits. Self-insureds are regulated by the Workers' Compensation Division to make sure they follow workers' compensation laws and procedures.
Small Business Ombudsman
An individual who is employed by the Department of Consumer and Business Services to provide information and assistance to small businesses about workers' compensation insurance and claims processing matters.
Standard premium
Manual premium multiplied by the insured's experience rating modification. (See Experience Rating Modification.) Standard premium does not include any premium discounts. (See Premium Discount.)
State fund
A fund set up by a state government to finance a mandatory insurance system such as workers' compensation, nonoccupational disability benefits, or (in Wisconsin) state-offered life insurance. It may serve as a monopoly or as an alternative to a private insurance carrier.
Stipulated settlement
An agreement between the insurance carrier and the injured worker who has raised a dispute concerning claims processing or impairment evaluation. This agreement must be approved by all parties and signed by a Workers' Compensation Board administrative law judge. These settlements are used to resolve differences between carriers and workers in order to avoid formal hearing situations.
Subcontractor
A contractor who performs work according to a contract with a prime contractor.
Subject employer
An employer with one or more subject workers in Oregon. All subject employers are required to provide workers' compensation coverage for those workers.
Subject worker
Most Oregon workers are considered "subject" to Oregon workers' compensation requirements; however, there are numerous exclusions under ORS 656.027. A few examples of excluded workers are: domestic servants, workers who provide casual labor, sole proprietors, and certain taxicab or medical transportation drivers.
Surplus
Policyholder reserves needed to protect against unknown, unanticipated needs. To determine surplus, an insurer will calculate the difference between their assets (stocks, bonds, etc.) and their liabilities (premium and claims reserves).
T
TL - Time loss
TPD - Temporary partial disability
TRIPRA - Terrorism Risk Insurance Program Reauthorization Act of 2007
TTD - Temporary total disability
Temporary partial disability (TPD)
A prorated time-loss payment that is made to an injured worker who has temporarily returned to a modified job at a salary that is less than the wage at time of injury.
Temporary total disability (TTD)
A time-loss payment that is made to injured workers whose disabilities are temporary, but severe enough that their treating doctors remove them from all work activities. Time-loss payments (66 2/3 percent of the worker's salary), subject to minimum and Average Weekly Wage maximum guidelines, are calculated according to the worker's wages at time of injury.
Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) of 2007
The Terrorism Risk Insurance Program Reauthorization Act of 2007 was enacted by Congress to extend and amend the Terrorism Risk Insurance Act of 2002. The Act creates a federal terrorism reinsurance program to serve as a federal backstop for insurers in the event of terrorist attacks.
Third-party claim
When someone other than the injured worker's employer or co-worker is responsible for an accident, a third-party claim may be established. Third-party cases involve three major areas: product liability, motor vehicle accidents, and personal liability. Recoveries from third party claims may be applied retroactively against claim costs, which help reduce premiums.
Three-way law
The law enacted by the Legislature and effective January 1, 1966, giving subject employers the option of purchasing workers' compensation coverage from private insurance carriers or the State Accident Insurance Fund. In addition, employers who can demonstrate adequate financial resources can self-insure their businesses.
Time loss benefits
Payments made to injured workers who are unable to perform all or part of their job functions as result of their injuries or disease. (See temporary partial disability and temporary total disability.) Compensation is due 14 days from date of employer notice or knowledge or date of disability, whichever is later for new claims. For aggravation claims, payments are due 14 days from receipt of the approved claim form (F827) accompanied by medical verification of inability to work as a result of a worsened condition. Subsequent payments after the initial payment are due every 14 days from the date of the first payment.
Time loss compensation
Also known as temporary total disability or temporary partial disability, are benefits designed to replace lost wages resulting from a work injury or occupational disease. Time loss compensation is calculated based on administrative rules and uses the wages earned at the time of the injury or occupational disease. The first time loss payment is generally due 14 days from the date of the employer’s knowledge. Subsequent payments, if any, are due every 14 days. A medical provider qualify to provide medical treatment in workers’ compensation claim must verify the worker’s inability to work prior to the payment of these benefits.
Transitional work
A modification to an injured workers' responsibilities or work schedule to accommodate the physical limitations resulting from the injury or disease.
U
Underwriting
The process of selecting risks and classifying them according to insurability so that appropriate rates are assigned. This process includes rejection of risks found unacceptable by the carrier.
United States Longshore & Harbor's Workers' Act (USL&HW)
The United States Longshore & Harbor’s Workers’ Act provides workers’ compensation benefits for employees (not crew members) of private employers whose employees are engaged in maritime employment. Maritime employment has customarily been interpreted to refer to work on, in, or adjacent to an interstate or international body of water loading or unloading a vessel; building a vessel; repairing a commercial vessel; or work supportive of these activities. Adjoining areas include an adjoining pier, wharf, terminal, dry dock, building way, marine railway, or other area adjoining such navigable waters customarily used for loading, unloading, repairing or building a vessel.
Unscheduled disability
A permanent partial injury to any area of the body not listed under the Scheduled Disability portion of the Workers' Compensation Law, primarily the head, neck, back, or trunk. This disability also results in a loss of wage-earning capacity. The amount of Unscheduled Disability awarded is calculated based on a formula using various factors such as age, education, training, adaptability to perform given job skills, and work experience. This disability may be due on claims with a date of injury prior to January 1, 2005.
V
Vocational assistance
The general terminology for activities designed to return injured workers to meaningful, gainful employment, whether it be through a return-to-work program, on-the-job training, formal schooling, or other forms of vocational retraining.
W
WCB - Workers' Compensation Board
WCD - Workers' Compensation Division
WCD assessments
The Workers' Compensation Division (WCD) charges an assessment on premiums paid to insurance carriers by employers. This assessment, paid when premiums are due (annually, quarterly, or monthly), funds WCD and Workers' Compensation Board (WCB) operations. The WCD also levies a cents-per-hour assessment on both employers and workers, primarily to fund worker rehabilitation programs. The cents-per-hour assessment is collected by the Department of Revenue.
Workers' Compensation Board (WCB)
A division within the Department of Consumer and Business Services (DCBS) responsible for resolving claim disputes between injured workers and insurance carriers. This board of five full-time members administers the Workers' Compensation Division Hearings Division and reviews appealed orders of workers' compensation administrative law judges. It also exercises "own motion" jurisdiction. (See Own Motion Claim.) Board members represent labor, employers, and the public and are appointed by the governor. The Board has its own budget and rule-making authority.
Workers' Compensation Division (WCD)
A division of the Department of Consumer and Business Services that is responsible for enforcing and regulating Oregon's workers' compensation law. The WCD is funded through a premium assessment collected by insurers. (See WCD Assessments.)
Workers' Compensation System
The Oregon workers' compensation system provides coverage to employers and benefits to injured workers. The system includes the Governor, Legislature, Department of Consumer and Business Services, Workers' Compensation Board and appellate courts, insurance carriers, employers, injured workers, medical care providers, and the National Council on Compensation Insurance. Oregon has a "no fault" system which guarantees benefits to workers with job-related injuries and diseases regardless of their cause and protects employers against liability.