Timothy Cline Insurance Agency, Inc.
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Definitions
Agreed Medical Examiner (AME): A physician who may be selected
by the parties together, when an injured worker is represented
by an attorney, to assess any disputed medical-legal issues.
Consequential Bodily Injury: In Workers Compensation,
special circumstances can arise when a work-related injury causes
some sort of non-work related injury. (Please see Loss of Consortium,
Dual Capacity, and Third Party Over glossary definitions.)
Dual Capacity: In Workers Compensation an employer
may be doubly liable to an employee who incurs bodily on the
job
as a result of using a product or service produced by that employer.
The employee is eligible for Workers Compensation benefits and
may also sue the employer because of the defectiveness of the
injuring product or service.
Employee: Every person in the service of an employer for
whom the employer is obligated to provide workers' compensation
benefits.
Employers Liability Insurance Agency, Inc.: Provides coverage against
the common law liability of an employer for injuries to employees,
as distinguished from the liability imposed by the workers' compensation
laws.
Experience Modification: The adjustment of premium resulting
from the use of experience rating. Experience rating plans reflect
an insured’s past loss experience (usually from the past
three years) and use this experience to modify and determine
the premium for the current policy year.
First Aid injuries: An injury is considered First Aid
if it involves one-time treatment and, if necessary, a follow-up
visit to observe minor scratches, cuts, burns, splinters etc.
Such minor injuries ordinarily do not require ongoing medical
care. A First Aid injury can be treated either by a peer/supervisor
or a medical professional such as a nurse or doctor.
Fraud: An intentionally deceptive act committed to obtain
an unfair or unlawful advantage. Fraud usually involves monetary
gain.
Frequency: The number of times a loss occurs.
Hazard: A circumstance that increases the likelihood or
potential severity of a loss.
Indemnity: In a property and casualty contract, the objective
is to restore an insured to the same financial position after
the loss that the insured had prior to the loss. In the most
basic sense, indemnity is compensation for a loss.
Claim: Notice to an insurance company that a loss has
occurred that may be covered under the terms and conditions of
the policy.
Claim Adjuster: The person who evaluates the damage caused
by a covered loss and determines the amount to be paid under
the policy terms.
Independent Adjuster: A person or organization that provides
claim adjusting services to different insurers on a contract
basis.
Limits of Insurance Agency, Inc.: The maximum amount of benefits the
insurance company agrees to pay in the event of a loss.
Loss of Consortium: A potential situation in any bodily
injury claim (including Workers Compensation claims) where a
spouse contends that the bodily injury of their partner deprives
them of the natural affection (spousal duties), help, and companionship
of said spouse.
Occupational Accident: A work-related accident that injures
an employee.
Occupational Disease: An illness contracted as a result of employment-related
exposures and conditions.
Occupational Hazard: A condition that exists in an occupation
and surrounding work environment that increases the peril of
accident, illness, or death.
Payroll: Usually synonymous with compensation, gross wages,
or salary. The most common basis for determining workers' compensation
insurance premiums. For most classifications, rates are based
on $100 of payroll.
Permanent Disability Rating Schedule: The schedule that
is used to determine and modify the percentage of permanent disability
of an injured worker.
Qualified Medical Evaluator (QME): Appointed and regulated
by DWC Medical Unit, a QME assesses an injured worker’s
permanent impairment and limitations and evaluates a wide variety
of disputed medical-legal issues. Often, a QME performs a separate
medical evaluation when the treating physicians assessment is
disputed.
Subrogation: The process of recovering the amount of claim
damages paid out to a policyholder from the legally liable party.
When a company pursues the legally liable third party, they are
required to include the policyholder’s deductible in the
recovery process.