Glossary of Workers’ Compensation Terms

Abey a Case:

To refile a case, with a notation that an Examiner is to review the case by a specified future date.

Abey an Issue:

To postpone a decision on an issue in a case until a later date, when it is expected than additional pertinent information may or will be available.

Accident (Work-Related):

(WCB) An event, arising out of and in the course of employment, that results in personal injury to a worker.

Accident Date:

(WCB) Refers to either (a) the date the accident is deemed to have occurred or (b) the date of onset assigned to an occupational disease. The accident date is officially established by a Law Judge.

Accident, Notice and Causal Relationship (ANCR):

(WCB) Minimal conditions that must be met before financial responsibility can be assigned to a claim for workers’ compensation. Specifically, it must be established that
• a work-connected accident covered by the Workers’ Compensation Law occurred;
• following the accident, the claimant notified his/her employer within the time limit required by the Workers’ Compensation Law; and
• a causal relationship exists between the accident and a resulting injury or disability.

Adjourn (a Hearing):

(WCB) To put off or suspend until a future time, without making any findings.

Adjudication:

The act or process of adjudicating. A judicial decision or sentence.

Appeal:

(WCB) A legal action taken by one of the parties to the Appellate Division, Third Department, to reverse or amend a decision or direction made by a Board Panel or the Chair of the Workers’ Compensation Board.

Apportionment:

(WCB) A proportionate division of all or part of the liability in a case between two or more sources of disability for the same claimant, based on an evaluation of the relative contribution that the sources of disability have made to the claimant’s permanent disability.

Arising Out of and in the Course of Employment:

(WCB) Two necessary conditions that must be met to establish a work-connected accidental injury; an injury that “arises out of” is one that results from a hazard of the employment, while an injury “in the course of employment” is one that occurred at a time, place and under circumstances related to the employment.

Attorney Fees:

(WCB) Fees approved by the Board for claimant attorneys in workers’ compensation cases. Under WCL .24, no claims for services or supplies are enforceable unless approved by the Board and, if approved, such claims become a lien upon the compensation awarded.

Average Weekly Wage (AWW) for Workers’ Compensation Claims:

Wage used to calculate total disability benefit rates for most claimants. Defined at 1/52nd of the injured worker’s average annual earnings (200-300 times average daily wage, depending on work schedule), based on the prior year’s payroll data. If an injured worker has not worked a substantial portion of the immediately preceding year, the average wage of a comparably employed worker is used in the Board’s calculations.

Average Weekly Wage (AWW) for Disability Benefits Claims:

Wage used to calculate disability benefit rates. AWW for disability benefits is based on the disabled employee’s earnings during the eight weeks prior to the start of disability.

Board Panel:

(WCB) A panel, usually comprised of three Workers’ Compensation Board members (at least one of whom must be a lawyer), that reviews requests to amend decisions made by Workers’ Compensation Law Judges, reopens closed cases and considers applications for lump sum non-schedule adjustment awards.

Calendar:

A list of the cases scheduled to be heard on a given date at a specific part at a district office or hearing point.

Cancel (a Case):

(WCB) An action by the Board to nullify indexing when two case numbers are assigned to a single claim.

Case:

(WCB) A reported work injury or illness which has been assembled and assigned a case number (indexed) by an indexing unit of the Workers’ Compensation Board.

Case Number:

(WCB) A unique identifier assigned by the Workers’ Compensation Board at the time a case is assembled. The case number consists of 8 characters and begins with an alpha character, followed by seven numeric characters. For example, G1234567.
•Volunteer ambulance workers’ cases will begin AA, followed by six numbers (e.g. AA123456).
•Volunteer firefighters’ cases will begin with FA, followed by six numbers (e.g. FA123456).

Cause of Accident:

(WCB) Object, substance or condition that directly contributed to the occurrence of an accident.

Causation/Causative Factor:

The fact of being the cause of something produced or of happening. The act by which an effect is produced. An important doctrine in fields of negligence and criminal law.

Claim:

(WCB) A request, on a prescribed Form C-3, for workers’ compensation for work-connected injury, occupational disease, disablement, or death (Form C-62). A claimant must file a claim within a two-year period from the occurrence of the accidental injury, knowledge of occupational disablement, or death. Failure to file a claim may bar an award for compensation unless the employer has made advance benefit payment or fails to raise the issue, in which event the claim filing requirement is deemed waived.
(NYCIRB, Carriers) A demand for payment or recovery for loss under an insurance contract. Cases are counted as claims only when a payment is made (for indemnity and/or medical benefits) or a reserve is established.

Claims Information Systems (CIS):

(WCB) A data system used by the Board’s Claims Unit to record basic case information such as parties of interest, current issues and scheduled hearings. CIS has historically been utilized in calendaring of cases (i.e., establishing hearing schedules) and in case identification.

Classification Code:

(NCCI, NYCIRB) A system of insurance risk classification based on industrial or occupational categories, supported by the National Council on Compensation Insurance and in use in about 40 states where private insurance is available. The system, which includes several thousand 4-digit numeric codes (with more than 700 classifications in use in New York), is extensively used to identify an employer’s rate making class(es) and establish basic pricing for workers’ compensation insurance.

Close (a Case):

(WCB) To remove a case from further consideration; a decision to close a case is based on a judge’s determination that no further rulings by the Board will be necessary in the case. A case closing is effected by a statement on a WCB decision (e.g., “Case is closed.”). The closing date is the date of the hearing or the effective date of the decision. A Board Panel may also close a case.

Compensated Cases Closed (CCC):

(WCB) A data system used to summarize cases that have been closed with an award of indemnity benefits during a particular calendar year. The annual files generally contain 120,000-140,000 case records and include information about case/claimant background, employment, injury/accident characteristics, extent of disability, indemnity benefits and selected decision characteristics.

Conciliation:

(WCB) A Workers’ Compensation Board process established to resolve, in an expeditious and informal manner (e.g. through meetings or telephone conferences), issues involving non-controverted claims in which the expected duration of benefits is fifty-two weeks or less. Failure to reach an agreement through the conciliation process results in the case being scheduled for a hearing.

Contested:

To bring an action at law. To make the subject of dispute, contention, or litigation.

Continue (a Case):

(WCB) To complete a hearing on a case without closing the case, leaving additional matters to be resolved at a future hearing.

Controverted Claim:

(WCB) A claim challenged by the insurer on stated grounds. The Board sets a pre-hearing for the determination of the grounds and directs the parties to appear and present their case.

C-2:

A Board form titled “Employer’s Report of Work-Related Accident or Occupational Disease” filed by employers within ten days after an accident occurs, as required by WCL .110. The form includes a section identifying the case and principal parties and additional sections labeled “Accident,” “Injured Person,” “Nature of Injury,” “Cause of Accident,” and “Fatal Cases.” Failure to make timely C-2 filings subjects employers to potential administrative and criminal penalties.

C-3:

A Board form titled “Employee’s Claim for Compensation,” that should be completed by the injured worker and submitted to the Board within two years of the accident or onset date. The C-3 form contains much of the same information as the C-3 (sections describing the Injured Person, Employer, Place and Time of accident, Injury, Nature and Extent of Injury, Medical Benefits received, Compensation Benefits received/claimed, etc.).

C-4:

A Board form titled “Attending Doctor’s Report,” that requests information about claimant/claim identification, claim parties of interest, injury history, diagnosis, treatment, disability, causal relation of accident to disability, and degree of impairment. The form is to be filed by the doctor within two days of initial treatment, with additional reports during continued treatment, including a final report.

C-7:

A Board form titled “Notice that Right to Compensation is Controverted,” that a carrier (as appropriate) must file within (1) 18 days of the date disability begins or (2) ten days of the date the employer first had knowledge of the alleged injury, whichever is later. Within 25 days from the Board’s mailing of a notice of indexing in volunteer firefighter or volunteer ambulance worker cases.) The form contains
• information identifying the claim, person (allegedly) injured, employer and carrier,
• a description of the alleged injury and town/county/state where alleged injury occurred,
• reasons why right to compensation is controverted,
• dates for start of alleged disability, employer/carrier first knowledge of injury, receipt of a C-2 from the employer and
• statement concerning whether notification has been given to the disability benefits insurance carrier, and date of notification.

C-8/8.6:

A Board form titled “Notice that Payment of Compensation for Disability has been Stopped or Modified,” that carriers are required to file within 16 days of the date on which benefit payments are stopped or modified. The form includes
• information identifying the claim, injured person, employer and carrier,
• a summary of total disability benefits, partial disability benefits and disfigurement awards paid,
• a summary of the claimant’s return-to-work and earnings status and
• if appropriate, an explanation of why indemnity benefits have not been paid in full. Depending on circumstances cited by the carrier and the claimant’s response, the filing of a C-8/8.6 may or may not trigger an immediate hearing.

Debarment:

The 2007 Workers’ Compensation Reform Legislation included provisions that would prevent employers that had various types of workers’ compensation noncompliance infractions from bidding on Public Work Projects. NYS governmental entities including State, county and municipal agencies may not contract with businesses that are listed on a Debarment List.

Decision:

A determination arrived at after consideration. A report of a conclusion.

Decision and Award Data System (D&A):

A recently added component of the Board’s Claims Information System designed to facilitate production of trial calendar decision notices and other materials prepared by Claims unit keyboard specialists. The system is also being developed as a source of information about case/decision characteristics and indemnity benefits.

Dependent

A person eligible to receive death benefits in a fatal injury case; the regular receipt of contributions by the alleged dependent upon which he/she relies and needs to sustain his/her customary mode of living constitutes dependency. Surviving widows and children under age 18 years are eligible for benefits without proving dependency, and other eligible recipients (if dependency is established) may include dependent handicapped children over age 18 years of age, grandchildren, brothers and sisters under age 18, dependent parents and grandparents.

Disablement:

To deprive of legal right, qualification, or capacity. To make incapable or ineffective; esp: to deprive of physical, moral, or intellectual strength.

District:

(WCB) One of the Board’s ten regions of New York state. The regions are Albany, Binghamton, Brooklyn, Buffalo, Long Island, Manhattan, Peekskill, Queens, Rochester and Syracuse.

Examiner:

(WCB) Incumbent in the Workers’ Compensation Examiner job title series who performs examining work, applying knowledge of law and of Board rules, regulations, policies and procedures to compensation and disability benefit case information. Among the actions regarding workers’ compensation cases that Examiners may perform:
• determining whether a case should be indexed;
• evaluating claim forms and developing information required by judges for case decisions;
• requesting information (by phone, letter, etc.) needed for case development;
• evaluating whether a compensation case may be processed on an informal calendar;
• referring appropriate cases to the conciliation process; and
• preparing formal notices of decision based on judge’s directions.

Exclusive Remedy:

The premise on which the Workers’ Compensation system is based: workers gave up the right to sue the employer in exchange for medical care for payment for their injuries.

Experience Rating:

A method for determining an employer’s workers’ compensation premiums that reflects a) a comparison of the employers recent loss experience with the amount the employer would have been expected to pay if it had been an average employer in the same industry with the same payroll and b) the credibility or confidence assigned to the employer’s loss experience. In practice, insurers assign no credibility to employers with average class premiums below a certain amount (e.g., $5,000/yr).

Extent of Disability:

(WCB) A single-digit numeric code used by the WCB’s Research and Statistics unit to characterize the disability classification assigned to a case closed with indemnity benefits. The codes are:

0 = Death case

1 = Permanent total disability

2 = Permanent partial disability (PPD) – Schedule award only

3 = Facial disfigurement award only

4 = Schedule PPD and facial disfigurement award

5 = Temporary disability only

6 = Temporary disability and facial disfigurement award

7 = Non-schedule PPD – Lump sum settlement

8 = Non-schedule PPD – No present loss of earnings

9 = Non-schedule PPD – Carrier to continue payments

Final Adjustment Hearing:

(WCB) A hearing held in cases involving the loss or loss-of-use of a member or organ of the body in which the principal issue is the extent of loss or loss-of-use (e.g., claims normally involving schedule awards).

Hearing:

(WCB) The WCL provides that no case may be closed without notice to all interested parties, with all such parties having an opportunity to be heard. Board hearings are held before Workers’ Compensation Law Judges who hear and determine claims for compensation, for the purpose of ascertaining the rights of the parties. The Board, upon receipt of an application for review of a judge’s decision, may also hold hearings.

Hearing Point:

Facilities, other than the seven District Offices, for which calendars are prepared and at which hearings are held.

Indemnity Benefits:

Compensation paid to the workers’ compensation claimants for non-medical loss resulting from an injury or illness. Six types of award are permitted by the WCL:
• temporary total disability benefits (for periods of total wage loss);
• temporary partial disability benefits (for periods of partial wage loss);
• facial disfigurement awards (at judge’s discretion but subject to a maximum, for cosmetic facial disfigurement resulting from the accident or exposure);
• permanent partial disability benefits (for loss if physical function or for periods of partial wage loss after a claimant has been classified as having a permanent partial disability);
• permanent total disability benefits (for loss of wage earning capacity after a claimant has been classified as having a permanent total disability); and
• death benefits (compensation benefits awarded to spouse, children or under certain circumstances, other family members following a work-related death).

Indexed Claim:

(WCB) A claim case folder which has been assembled and assigned a case number by the Board’s Claims Unit.

Judge:

See Workers’ Compensation Law Judge.

Jurisdiction:

(WCB) The right to hear and determine a workers’ compensation case. The Board has jurisdiction over cases with employment in NYS. Notable exclusions from the Board’ jurisdiction in New York State include: federal government workers and certain employees of local government, many NYC government occupations (civil service police, firefighters, sanitation workers), most NYC teachers, and casual employments (yard work by minors, baby-sitters, etc.). Workers covered by separate compensation systems under federal laws (maritime employments, merchant seafarers, interstate railroad employees, etc.) may elect to submit to NYS jurisdiction by waiving their federal rights and remedies. Coverage for some worker classes in NYS is elective (e.g., part-time household workers, sole proprietors, corporate officers, certain musicians, and farm workers earning less than $1,200 per year).

Licensed Representative:

(WCB) (a) Any person other than an attorney who is authorized by the Board to represent claimants or insurance carriers before the Board and, in some instances, to receive a fee, fixed by the Board, for such services. (b) Any person other than an attorney who is authorized by the Board to represent self-insurers before it.

Licensed Claimant Representative:

(WCB) (a) Any person other than an attorney who is authorized by the Board to represent claimants or insurance carriers before the Board and, in some instances, to receive a fee, fixed by the Board, for such services. (b) Any person other than an attorney who is authorized by the Board to represent self-insurers before it.

Lost Time:

(WCB) A period of total wage loss and loss of earning capacity, beyond the statutory waiting period, caused by the claimant’s work-connected disability. In workers’ compensation cases only, if the disability period exceeds 14 days, compensation will be paid from the first day of disability. There is no waiting period for volunteer ambulance worker or volunteer firefighter cases.

Lump Sum Settlement:

(WCB) A negotiated and Board-approved agreement, termed a “non-schedule adjustment,” between a claimant with a non-schedule permanent partial disability and the insurer(s). As a result of the agreement the claimant receives a sum of money representing all future compensation for his/her disability, and the case is considered closed. Under WCL .15(5-b), granting of a settlement by the Board requires that (a) the right to compensation has been established and compensation has been paid for at least three months, (b) the continuance of disability and of future earning capacity cannot be ascertained with reasonable certainty, (c) there has been a physical examination of the claimant prior to approval, and (d) the Board considers the settlement “fair and in the best interest of the claimant.” In practice, lump sum settlements are usually final, but the law provides for reopening’s if the Board finds that there has been a change in condition or degree of disability not contemplated at the time of the settlement.

Manual Rates:

The listed premium, stated as dollars per $100 of weekly earnings for each employee, in a state’s current schedule; in New York the manual rates are linked to the Classification Code system (i.e., rates are stated for each work classification code used in the state).

Maximum Medical Improvement (MMI):

(WCB) An assessed condition of a claimant based on medical judgment that (a) the claimant has recovered from the work injury to the greatest extent that is expected and (b) no further change in his/her condition is expected. A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.

Medical Benefits:

Medical treatment provided, under the Workers’ Compensation Law, to injured workers as a result of injuries arising out of and in the course of employment.

Medical Fee Schedule:

A schedule, established by the Chair of the Workers’ Compensation Board, of charges and fees for medical treatment and care furnished to workers’ compensation claimants.

Medical Treatment:

(WCL) Care (other than first aid) administered by a physician, chiropractor or podiatrist or on a physician’s referral, by a psychologist, or physical or occupational therapist.

Misclassification:

(An action by an employer to intentionally attempt to reduce required workers’ compensation insurance premiums by misclassifying employees as “independent contractors”, and/or misclassifying the work that of a business to a classification that is less hazardous. An employer must keep accurate records of the number of employees, classification, wages and accidents for their business for four years. Failure to keep adequate and/or accurate records may result in a fine of $1,000 per every 10-day period of noncompliance or two times the cost of compensation. Additionally, the fine for criminal conviction is from $1,000 to $50,000.

Misrepresentation:

An action by an employer to intentionally attempt to reduce required workers’ compensation insurance premiums by not keeping accurate/adequate payroll records, paying workers “off the books”, misclassifying employees as “independent contractors” and/or misclassifying the work that of a business to a classification that is less hazardous. An employer must keep accurate records of the number of employees, classification, wages and accidents for their business for four years. Failure to keep adequate and/or accurate records may result in a fine of $1,000 per every 10-day period of noncompliance or two times the cost of compensation. Additionally, the fine for criminal conviction is from $1,000 to $50,000.

Modify a Decision:

A decision that partially changes a previous decision — e.g., a Board Panel memorandum of decision which amends a Workers’ Compensation Law Judge decision.

Motion Calendar Hearing:

(WCB) In a case in which no controversy or outstanding issue exists, a proposed decision is prepared and the parties are notified. A hearing is held only if one of the parties objects to the proposed decision.

National Council on Compensation Insurance (NCCI):

An association of workers’ compensation insurers which serves as the workers’ compensation rating organization in about two-thirds of the states. The group establishes standards for use in rate making, develops policy forms, collects statistics, and provides statistical support and services.

National Institute for Occupational Safety and Health (NIOSH):

An agency within the U.S. Department of Health and Human Services established in 1970. It is part of the Center for Disease Control and Prevention and is generally responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. NIOSH’s responsibilities include: investigating potentially hazardous working conditions (as requested by employer or employees), evaluating workplace hazards, creating and disseminating methods for preventing disease/injury/disability, conducting scientifically valid research on safety issues, and providing education and training in the field of occupational safety and health.

New York Compensation Insurance Rating Board:

A private, non-profit association of licensed insurance companies that provide workers’ compensation insurance in New York; the organization is responsible (among other things) for collecting and reviewing compensation loss experience from carriers, developing policy forms and rating plans, conducting actuarial analyses and preparing rate filings with the New York State Insurance Department.

Non-Compensated Case:

A closed case which has never awarded indemnity benefits.

Non-schedule Permanent Partial Disability:

Non-fatal injuries that do not involve schedule permanent partial disabilities or cosmetic facial disfigurement and in which the claimant retains some earning capacity are assigned permanent disability benefits based on the claimant’s actual or presumed wage loss, with benefits to continue for the duration of the wage loss disability.

Notice:

Written notification from an employee to his/her employer, indicating that a work-connected injury or injury has occurred. For accidental injuries, notice must be given no later than 30 days after the accident; the Board must excuse a failure to give notice on the grounds that a) for some reason, notice could not have been given; b) the employer had knowledge of the accident; or c) the employer’s case has not been prejudiced. In cases involving occupational diseases, the time period for notice is 2 years from the date of disablement or from the date when the employee knew, or should have known, that the disease was due to the nature of employment.

Occupation:

(Census Bureau) A numeric coding structure widely adopted by federal, state and private occupation analysts, for identifying the occupation of an injured worker.

Occupational Disease (OD):

A disease arising from employment conditions for a class of workers, with the disease occurring as a natural incident for particular occupations, distinct from and exceeding the ordinary hazards and risks of employment. To be considered an occupational disease, there must be some recognizable link between the disease and some distinctive feature of the workers’ job.

Occupational Disease, Notice and Causal Relationship (ODNCR):

(WCB) Minimal conditions that must be met before financial responsibility can be assigned to a claim for workers’ compensation based on occupational disease. Specifically, it must be established that (a) the claimant has an occupational disease recognized by the WCL, (b) the claimant has, after the onset of the disease, notified his/her employer within the statutory time limit (two years from date of disablement or from date when claimant knew or should have known that the disease was due to the nature of the employment, whichever is greater), and (c) a causal relationship exists between work-related activities and exposure, the development of the occupational disease, and a subsequent disability.

Occupational Illness:

Any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment; it includes acute and chronic illnesses or diseases which may be caused by inhalation, absorption, ingestion or direct contact.

Occupational Injury:

Any injury, such as a fracture, sprain, amputation, etc. – which results from a work accident or other exposure involving a single accident in the work environment.

Party of Interest:

The claimant, employer, carrier and any statutory fund that may be liable in the particular case.

Planned Coverage:

An employer may provide benefits under a Board approved Plan for Disability Benefits (or one negotiated by agreement and accepted by the Chair of the Board as meeting the requirements of the NYS Disability Benefits Law (DBL)) ONLY when such a Plan is insured through one of the carriers licensed by New York State to write statutory disability benefits insurance policies or by an employer who has been authorized by the NYS Workers’ Compensation Board to self-insure for disability benefits. All Plans accepted by the NYS Workers’ Compensation Board shall cover only those employees that are eligible for benefits under the NYS DBL. Such accepted Plans must meet ALL statutory requirements as set forth by the NYS DBL.

Premium:

The total amount paid for an insurance policy. For workers’ compensation insurance, premiums are normally calculated using a rate per $100 of the payroll for covered employees.

Reduced Earnings:

(WCB) A compensation rate based on the claimant’s partial wage loss or partial loss of earning capacity due to a condition related to a compensable work-connected injury.

Reimbursement, Request for:

A request by an employer for reimbursement for wages paid to an employee for a period during which the employee was eligible to receive workers’ compensation or disability benefits. A request by a compensation carrier for reimbursement out of the Special Disability Fund. A request by a disability benefits carrier for reimbursement of benefits paid to a claimant while the workers’ compensation case was being litigated.

Reopened Case:

A workers’ compensation case which has been closed by a Workers’ Compensation Law Judge or a Board Panel that is subsequently made active again to determine the claimant’s eligibility for benefits.

Reopened Cases Fund:

(WCB) A fund established to assume liability for additional awards in cases in which the application to reopen the case occurs more than seven years from the date of injury and more than three years from the payment of the last payment of compensation. The Fund is financed through payments in non-dependency death cases and through assessments made periodically against all carriers.

Request for Further Action:

When a Party-of-Interest in a case requests Board intervention.

Rescind (a Decision):

(WCB) A Board Panel memorandum of decision which voids or annuls a Workers’ Compensation Law Judge decision. Decisions to rescind are usually issued without prejudice in order to allow the parties to present evidence or testimony not previously presented to a Workers’ Compensation Law Judge.

Rescind (a Penalty):

(WCB): In certain instances the NYS Workers’ Compensation Board issues a penalty for noncompliance with the mandatory coverage provisions of the NYS Workers’ Compensation Law for workers’ compensation and/or disability benefits to a legal entity that is not required to carry such insurance policy(ies). The Workers’ Compensation Board will review documentation submitted by the legal entity that shows that such coverage is not required and the Workers’ Compensation Board will “rescind” (withdraw or cancel) the penalty action. The legal entity is not required to pay the penalty amount related to the rescinded penalty.

Review Bureau:

(WCB) A department of the Workers’ Compensation Board which processes requests for reopening’s of closed cases and objections to Workers’ Compensation Law Judge decisions. In addition, the unit previously processed requests to close compensation cases with lump sum non-schedule adjustments, but since 1995 such requests have been handled by the district offices.

Review, Request for:

(WCB) A written request for a Board Panel review of a Workers’ Compensation Law Judge decision.

Schedule Permanent Partial Disability:

(WCB) Maximum benefit week schedules in the WCL are generally used in determining lifetime benefits for injuries to major body parts. Injuries amounting to less than a 100 percent functional loss are awarded a percentage of the scheduled weeks, and there are also provisions for additional weeks required for a protracted healing period.

Second Injury Fund:

A special fund, technically known in New York as the Special Disability Fund, which assumes, in certain cases, part of the permanent disability liability resulting from injuries to previously handicapped workers. The fund, which is funded by assessments against carriers and self-insureds, was created to assure handicapped workers receive full workers’ compensation benefits, while encouraging employers to hire physically handicapped persons by protecting them against disproportionate liability in the event of subsequent employment injury.

Self-Insurance:

(WCB) In lieu of purchasing insurance from an insurance carrier, an employer or group of employers may assume the liability for the payment of workers’ compensation benefits to employees by depositing securities or a surety bond in an amount required by the Board.

Special Funds:

Funds established under the WCL to assure payments of benefits associated with claims, usually by transferring all or part of the liability to the Fund.

State Insurance Fund:

A quasi-public agency whose activities include a) providing workers’ compensation insurance coverage to private and public employers; b) providing other lines of insurance coverage; and c) acting as an agent in NYS in workers’ compensation cases involving NYS employees. The State Insurance Fund must offer workers’ compensation insurance to any employer requesting it, making the Fund an “insurer of last resort” for employers otherwise unable to obtain coverage.

Statutory Disability Benefits Insurance Policy:

New York is one of a handful of states that require employers to provide disability benefits coverage to employees for an off-the-job injury or illness. Cash benefits are 50 percent of a claimant’s average weekly wage, but no more than the maximum benefit allowed, currently $170 per week. Benefits are paid for a maximum of 26 weeks of disability during 52 consecutive weeks. Coverage for statutory disability benefits can be obtained through a disability benefits insurance carrier who is authorized by the NYS Workers’ Compensation Board to write such policies. Another option is for large employers to become authorized by the Board to self-insure.

Stop Work Orders:

A stop work order means that a business MUST cease all operations – no work at all may take place until the Stop Work Order is officially removed. Section 141-b of the WCL states that a business may be issued a stop work order if workers’ compensation coverage is not in place. Receipt of a stop work order may lead to disbarment from any State, municipal or public body Public Works contract or subcontract for 1 year (5 years for felony conviction).

Symptomatic Treatment:

Medical treatments aimed at providing relief from the symptoms of a disease or injury, rather than providing a permanent remedy to the underlying condition.

Tentative Rate:

A weekly rate assigned by the Workers’ Compensation Board for carrier indemnity payments, pending final adjudication of outstanding issues relating to benefit rates.

Third Party Action:

(WCB) This term refers to lawsuits against equipment manufacturers, facility owners and other non-employer parties whose products or services contributed to the occurrence of an accident. Under WCL, a compensation claim is a workers’ sole remedy against the employer, but lawsuits may be initiated against third parties for contributory negligence, product defects, etc.

Total Disability:

With meaning of workers’ compensation acts, means lack of ability to follow continuously some substantially gainful occupation without serious discomfort or pain and without material injury to health or danger to life.

Trial Calendar Hearing:

(WCB) A regularly scheduled hearing on a case conducted by a WCLJ that is designed to permit the introduction of evidence and/or witnesses and the presentation of arguments by the parties.

Uninsured Employers’ Fund:

A special fund which provides for the payment of workers’ compensation cases where the employer was not insured nor self-insured and has defaulted in the payment of workers’ compensation.

Wage:

See Average Weekly Wage.

Wage Expectancy:

(WCB) A decision element assigning an artificial wage rate to a young claimant, based on the authority of WCL .14(5).

Wage Replacement:

(WCB) The proportion of pre-injury wages replaced by workers’ compensation benefits.

Waiting Period:

(WCB) Period covering the first seven days of disability resulting from a work-connected injury or illness. Workers’ compensation indemnity benefits are not allowable for the first seven days of disability, except that (a) in cases where the disability period exceeds 14 days, indemnity awards are allowed from the date of disability, and (b) there is no waiting period for VAWBL/VFBL cases.

Workers’ Compensation Board, New York State (WCB):

(a) The agency charged with administering the Workers’ Compensation Law, the Volunteer Ambulance Workers’ Benefit Law and the Volunteer Firefighters’ Benefit Law and the Disability Benefits Law. (b) The thirteen member Board responsible (directly or through review of delegated authority) for determining all issues involving claims under the WCL. Members are appointed to seven-year terms by the Governor, by and with the advice and consent of the Senate. The Governor designates the Chair and Vice-Chair.

Workers’ Compensation Law (WCL):

Chapter 67 of the Consolidated Laws, governing the workers’ compensation system; separate laws cover compensation benefits for volunteer firefighters and volunteer ambulance workers.

Workers’ Compensation Law Judge (WCLJ; Compensation Claims Referee):

(WCB) An officer appointed by the Chair of the Workers’ Compensation Board from a Civil Service competitive process to hear and determine claims and to conduct such hearings and investigations and make such orders, decisions and determinations as may be required in the adjudication of the claims. A Judge’s decision is deemed the decision of the Board unless the Board modifies or rescinds such decision.

Guide to Common Workers’ Compensation Terms

15-8 Cases

§15-8 is a section of the NYS WC law relating to disability following previous permanent physical impairment. §15-8 no longer applies for loss dates after June 30, 2007.

§25-A is a section of the NYS WC law that applies to cases closed (NFA), in which the date of accident is more than seven (7) years ago, and in which the date of the last indemnity payment is more than three (3) years ago. If the WCB establishes 25-A, then medical and indemnity payments will be made by Special Funds Conservation Committee, and not the employer or insurance carrier.

A-Rate

An “A-Rated Classification” is a classification with no predefined manual rate shown in the rate pages of the NYCIRB Manual.

Accident Date

Refers to either (a) the date the accident is deemed to have occurred or (b) the date of onset assigned to an occupational disease. The accident date is officially established by a WCLJ.

Accident Notice and Causal Relationship (ANCR)

The finding made by WCLJ that the claimant sustained an accidental injury arising out of and in the course of employment; that timely notice was given to the employer; and that the disability is causally related to the accidental injury. (WC law § 2, Sub. 7; § 18)

Accident (Work Related)

An event, arising out of and in the course of employment, which results in personal injury to a worker.

Actuary

A person who calculates insurance and annuity premiums, reserves and dividends.

Adjourn (a hearing)

The Workers’ Compensation Board WCLJ can put off or suspend until a future time, without making any findings.

Adjusted manual rate premium

A premium level charged a risk under a NYSIF workers’ compensation policy, produced by applying an experience modification to the manual rate premium on either a deposit premium bill or an audit bill.

ADL

Activities of Daily Living.

Administrative Decision (AD)

In an effort to reserve the hearing calendar process for more complex cases, the WCB can make determinations on cases outside of the regular hearing process by administrative decisions.

Admiralty Law

The Merchant Marine Act of 1920 also known as the Jones Act (46 U.S. Code, § 688). This federal law, which is part of Admiralty Law, provides that masters and members of crews of vessels have the right to sue their employers for damages in Admiralty Courts for injuries sustained in the course of employment.

Advocate for Business

The New York State Workers’ Compensation Board Advocate for Business assists employers by resolving problems and answering questions about the New York State workers’ compensation system.

Advocate for Injured Workers

The New York State Workers’ Compensation Board Advocate for Injured Workers accepts complaints concerning matters related to workers’ compensation, and investigates and attempts to resolve them. In addition, the Advocate provides information to injured workers to enable them to protect their rights in the workers’ compensation system.

Affidavit

A written statement under oath or affirmation made or taken before an officer having authority to administer such oath.

 

Aggregate Trust Fund (ATF)

A trust fund established in 1935, under NYS WC law § 27, entrusting NYSIF as the administrator for the Trust to assure payment of workers’ compensation in claims involving permanent partial disability, permanent total disability, the loss of major members (limbs or eyes) and fatal injuries.

Anniversary Date

The date each year upon which the policy is renewed; usually based on the original inception date.

Appeal (Workers’ Compensation)

A legal action taken by one of the parties to reverse or amend a decision or direction made by a WCLJ, WCB board panel or the WCB Chair.

Applicant

The person or entity requesting insurance.

Apportionment

A proportionate division of all or part of the liability in a case between two or more sources of disability for the same claimant. Apportionment can involve another NYSIF case, another carrier’s case, or a prior existing medical condition of the claimant.

Arbitration

The adjudication process that determines the fair value of a disputed medical bill rendered by a physician, chiropractor, physical therapist, occupational therapist, podiatrist, or psychologist authorized to render treatment under the WC law.

Arising Out of and in the Course of Employment

Two necessary conditions that must be met to establish a work-connected accidental injury. (WC law § 2, Subd. 7)

Assignment of Interest

The transfer of an insurance policy from one person or entity to another.

Assured

See: insured

ATF (Aggregate Trust Fund)

See Aggregate Trust Fund

Attorney Fees

Fees approved by the WCB for claimant attorneys in workers’ compensation cases, which will be a lien on the award. (WC law §24)

Audit (NYSIF Premium)

The act of inspecting the accounting books, electronic accounts and tax records of a policyholder to determine the actual exposures, which existed during a specified period of time, in order to develop the proper premium.

Authorized Chiropractor

New York State licensed chiropractor authorized by the WCB Chair to render chiropractic care under the WC law within the limits prescribed by the Education Law.

Authorized Physician

New York State licensed physician authorized by the WCB Chair to render medical care or treatment under the WC law. (WC law § 13-b, Subd. 2)

Authorized Podiatrist

New York State licensed podiatrist authorized by the WCB Chair to render podiatry care or treatment under the WC law. (WC law § 13-k)

Authorized Psychologist

New York State licensed psychologist authorized by the WCB Chair to render psychological care under the WC law within the limits prescribed by the Education Law.

Authorized Representative

An individual or company whom the assured or applicant selects (in writing) to act as that assured’s agent. Some common examples of an authorized representative are an insurance broker, an insurance agent, an attorney and an accountant. When the assured is in a Safety Group, the Group Manager automatically becomes the assured’s representative.

Average Weekly Wage (AWW)

A calculation that reflects the employees’ average pay rate used as a basis for determining benefits in workers’ compensation insurance. (WC law § 14)

Award

Decision given by a WCLJ at a hearing to pay or not pay compensation and/or medical expenses to a claimant.

Binder

An agreement to furnish protection until an insurance policy can be issued. NYSIF does not use binders for workers’ compensation coverage.

Board Panel Review

Where a WCLJ’s decision is disputed, the aggrieved party may file an application for a review. (WC Law § 23, §224 and Board Rule 13)

Board Rates

The premium rates as defined by the New York Compensation Insurance Rating Board without any modification by a NYSIF discount or surcharge.

Broker

See: Insurance Broker

C-105

WCB prescribed form “Notice of Compliance, WC Law” informs employees at their place of employment of their rights under the WC law. Employers must obtain this form from their insurance carrier or licensed agent.

C-107

WCB prescribed form “Employer’s request for reimbursement”

C-11

WCB prescribed form “Employer’s Report of Injured Employee’s Change in Employment Status resulting From Injury”

C-2

WCB prescribed form “Employers’ Report of Work-Related Accident/Occupational Disease” filed by employers within 10 days after an accident occurs, as required by WC law § 110.

C-240

WCB prescribed form “Employer’s Statement of Wage Earnings (Preceding Date of Accident)” used to determine the claimant’s average weekly wage.

C-250

WCB prescribed form “Notice of Claim for Reimbursement Out of Special Disability Fund Under WC law §15-8.” A carrier cannot file a C-250 on cases with accident dates after June 30, 2007.

C-27

WCB prescribed form “Medical Proof of Change in Condition in Support of Application for Reopening,” filed in a closed case to show change in medical condition supporting the reopening of a claim.

C-3

WCB prescribed form “Employee’s Claim for Compensation” that should be completed by the injured worker and submitted to the WCB within two years of the accident or onset date. The C-3 form contains much of the same information as the C-2.

C-32

WCB prescribed form “Settlement Agreement for WC law §32”

C-4

“Attending Doctor’s Report and Carrier/Employer billing form” provides information about claimant identification, injury history, diagnosis, treatment, disability, causal relation of accident to disability, and degree of impairment. The form includes procedures performed and billing charges. The form is to be filed by the doctor within two days of initial treatment, with additional reports during continued treatment, including a final report. http://www.wcb.state.ny.us/content/main/Forms.jsp

C-7

WCB prescribed form “Notice That Right to Compensation is Controverted.” If a carrier or self-insured employer is challenging a claim, they must file on or before the 18th day after disability or within 10 days after the employer first had knowledge of the alleged injury, whichever period is greater.

C-8.1

WCB prescribed form “Notice of Treatment Issue/Disputed Bills” used to deny authorization for medical services or treatment and to object to a medical bill on the basis of necessity, causal relationship or other issues to be adjudicated by a WCLJ.

C-8 or C-8.6

WCB prescribed form “Notice That Payment of Compensation has been Stopped or Modified.” This notice must be filed by the insurance carrier or self-insured employer within 16 days after the date on which benefit payments were stopped or modified. C-8 is for Indemnity Benefits, and C-8.6 is for Death Benefits.

Cancellation

The act of terminating an insurance policy before its expiration date, either by the policyholder or by the company.

Carrier

An insurance company.

Carrier Case Number (CC#)

A unique identifier assigned by the insurance company at the time a case is created for a work-related injury or illness. This number is different than the WCB case number.

Causal Relationship

The connection between the claimant’s injury or illness and the work-related accident or disease. (WC law § 2, Subd. 7)

Cause of Accident

Workers’ Compensation Board definition: Object, substance or condition that directly contributed to the occurrence of an accident.

Certificate of Insurance

A document that provides evidence of the existence and terms of a particular policy.

Workers’ Compensation Certificate of Insurance

Disability Certificate of Insurance

Certified Safety Consultant

Safety and health staff designated as New York State Certified Safety Consultants (CSC) by the New York State Department of Labor. This credential can be used only by those persons who have qualified for and been issued a verification under the Workplace Safety and Loss Prevention Program (Industrial Code Rule 59, NYS Workers’ Compensation Law).

Chiropractic Fee Schedule

The schedule established by the WCB with charges and fees for chiropractic treatment and care furnished to workers’ compensation claimants. (WC law § 13-1)

Claim

A demand for an amount alleged to be due under an insurance policy following the occurrence or event against which the coverage protects.

Classification Code

A system of insurance risk classification based on industrial or occupational categories.

Classification Rate

See Rate

Clause

See Endorsement

CMS-1500

A uniform claim form created by the Centers for Medicare & Medicaid Services (CMS) used to bill for medical service rendered. (Formerly known as form HCFA-1500)

Compulsory

Required

Conciliation

A WCB process established to resolve, in an expeditious and informal manner (e.g. through meeting or telephone conferences), issues involving non-contested claims in which the expected duration of benefits is 52 weeks or less. Failure to reach an agreement through the conciliation process results in the case being scheduled for a hearing.

Concurrent Employment

If a claimant has more than one job, the compensation rate is calculated by adding the wages from all of the claimant’s jobs.

Consequential Accident

A second accident resulting from a prior accidental injury which arose out of and in the course of employment. (WC law § 2, Subd. 7)

Continue (a Case)

Completion of a hearing on a case without closing the case, leaving additional matters to be resolved at a future hearing.

Controverted Claim

A claim challenged by the insurer on stated grounds. The WCB sets a pre-hearing for the determination of the grounds and directs the parties to appear and present their case. (WC law § 25)

Coverage

Protection afforded by an insurance policy.

CPT

(Current Procedural Terminology) The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.

Death Benefit Award

Awarded by the WCB when the death of a claimant is causally related to the accident that initiated the claim. Benefits are payable in order of priority to: surviving spouse, then children, then all others with equal priority such as dependent parents, grandparents, grandchildren, brothers and sisters. Dependency is determined as of the date of the accident.

 

Death Claim

Claimant died as a result of a work-related injury.

Debtor in Possession

This term refers to a debtor that keeps possession and control of its assets while undergoing a reorganization under chapter 11 of U. S. Bankruptcy Code, without the appointment of a case trustee.

Decision

Determination arrived at after consideration by the WCB.

Declaration

A document issued by an insurance company on a new policy which contains specific information identifying the insured and the coverage afforded. Also known as a New Information Page.

Deductible

A policy provision that requires an insurer to only pay that amount of any loss which is in excess of a specified amount.

Deficiency Compensation

The compensation and medical benefits payable after the carrier has exhausted its credit against the claimant’s net third party recovery.

Department of Insurance (NYS)

The Department of Insurance is responsible for supervising and regulating all insurance business in New York State.

Dependent

A person eligible to receive death benefits in a work related fatal injury case. (WC law § 15)

Deposition

Witness testimony ascertaining the facts. Depositions are taken where witnesses cannot appear at a hearing before the WCB. The questions and answers are part of a proceeding before an official person. (WC law § 121; Board Rule 19)

Deviated Rates

Rates used which are different from those issued by a rating bureau (e.g. New York Compensation Insurance Rating Board)

Diagnostic Testing Network

A legally and properly organized network of providers or facilities that perform diagnostic tests, x-ray examinations, magnetic resonance imaging (MRI), or other radiological tests for claimants.

Differential

A premium rate charged by NYSIF that is greater than the sum of the loss cost in effect for the classification of employees and the applicable expense factor used by NYSIF.

Disability Benefits Insurance

New York State disability benefits insurance provides temporary cash benefits paid to an eligible wage earner when he/she is disabled by an off the job illness or injury, and for disabilities arising from pregnancies. Employers with one or more employees are subject to the provisions of the New York State Disability Benefits Law. The Disability Benefits Law provides weekly cash benefits to replace, in part, wages lost due to illness or injury that do not arise out of or in the course of employment. Disability benefits include cash payments only. Medical care is the responsibility of the claimant. Medical care is not paid for by the employer or insurance carrier.

Disability Insurance Rates

Disability insurance rates are determined by each insurer and approved by the Superintendent of Insurance. Currently, NYSIF rates are .20 cents per male employee and .40 cents per female employee, per $100 of payroll to a maximum weekly payroll of $340 per employee.

Disability (Partial)

Disability which allows a claimant to engage in some kind of gainful employment. The difference between the claimant’s pre-accident earnings and post-accident earnings is determinative of the reduced earnings rate. (WC law § 15, Sub.5, 5-a)

Disability (Total)

Disability which precludes a claimant from earning any wages. (WC law § 15, Sub.1,2)

Disfigurement

Serious and permanent disfigurement to the face, head or neck may entitle the injured worker to compensation up to a maximum of $20,000, depending upon the date of the accident.

Dividend

A portion of the premium which may be distributed to a Disability Policyholder or Safety Group policyholder.

Earning Capacity

The ability of a claimant, who has suffered a work-related disabling injury, to earn wages in the labor market. (WC Law § 15, Sub. 5-a)

Effective Date

The date coverage begins on a policy.

eFROI

Employer’s First Report of Injury via the Internet. eFROI

Employee

One who, for a wage or salary, or as a volunteer, performs services for another under a contract of hire, acting under the direction and control of the person by whom she/he is hired. (WC Law § 2, WC Law § 201)

Employer’s Liability

The responsibility of an employer to reimburse an injured employee for accidents occurring in the course of employment. Such liability is separate from and is in addition to any statutory liability created under Workers’ Compensation Law. Employer’s liability is usually insured by a separate section (1B) under a workers’ compensation policy.

Endorsement

A form attached to a policy in order to modify its terms.

Entity

A person, partnership, corporation or political subdivision that can be shown as a named insured in a policy. A legal entity can be served with legal notice and sued in a court of law.

EOB

See Explanation of Benefits

Excess Loss Limit

Within the context of a NYSIF safety group, it is a monetary amount above which the remaining cost of a claim is paid by reinsurance or the NYSIF and is not deducted as a loss against a safety group’s contingent balance or surplus.

Exclusion

A provision in an insurance policy that indicates what is denied coverage under that policy.

Exclusive Remedy

The legislature has established the Workers’ Compensation Law as the exclusive remedy of an employee and his /her dependents in a death case, against the employer who has secured workers’ compensation. It is the sole recourse that the injured employee, dependents or representatives have against the employer for injuries or death resulting from a work-connected accident or occupational disease. If an employer who is required to secure workers’ compensation insurance fails to do so, the employee, if disabled due to a work-connected injury, has the right to elect to either claim workers’ compensation or to maintain an action against the uninsured employer for damages. (WC Law § 11)

Executive Officer

A corporate president, vice-president, secretary or treasurer appointed in accordance with the charter or by-laws of such corporation.

Expense Constant

A policy fee charged on every WC policy, regardless of premium size, to compensate for the basic costs of administering the policy.

Expense Factor

See Loss Cost Multiplier.

Experience

The record of losses that is used in predicting future losses and in developing premium rates.

Experience Modification

A percentage higher than or less than 100% by which the Manual Rate Premium is increased (experience rate charge) or decreased (experience rate credit) when a risk is eligible for the Experience Rating Plan.

Experience Rating

A form of individual risk rating which takes into consideration the loss experience of the particular risk as a credit or a debit to the manual rate for the employer’s classification.

Explanation Of Benefits (EOB)

An itemization of services provided, amount billed, amount paid, and an explanation of the difference for all payments included in a check (also known as ‘draft’).

Facial Disfigurement Award

An award of compensation for serious permanent facial or head disfigurement. (WC Law § 15, Sub. 3)

Final Adjustment (FA) Hearing

WCB hearing held in cases involving the loss or scheduled loss of extremities, sight, hearing, or facial disfigurement in which the principal issue is the extent of loss or loss-of-use. (WC Law § 15, Sub. 3)

Fraud

Any person who, knowingly and with intent to defraud, presents causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer or purported insurer, or any agent thereof, any written statement as part of or in support of, an application for the issuance of or the rating of an insurance policy for compensation insurance or a claim for payment or other benefit pursuant to a compensation policy which he or she knows to (i) contain a materially false statement or representation concerning any fact material thereto, or (ii) omits any fact material thereto, shall be guilty of a class E felony.

FROI

An acronym used in the insurance industry for First Report of Injury.

Functional Capacity Evaluation (FCE)

Type of medical exam which helps to verify and determine a claimant’s physical capacity.

Fund for Reopened Cases

A fund created under the WC law to assume liability for claims of compensation in certain “stale” cases where specified time limits have elapsed. (WC law § 25a, § 51, Volunteer Firefighters’ Benefit Law and Volunteer Ambulance Workers’ Benefit Law)

General Contractor

An individual or business firm who contracted to perform all or part of a specified job.

General Employer

The general employer is the regular or parent employer who makes the employee available to a special employer. The general employer usually exercises indirect control. Either may be liable for the compensation due to the injured employee. (WC law § 2, Sub.3,4)

General Liability Insurance

Coverage for an insured when negligent acts and/or omissions result in bodily injury and/or property damage to a third party.

Governing classification

The classification which describes the operations of the employer and produces the greatest amount of payroll.

Guaranteed Cost

A premium charged on a prospective basis, fixed or adjustable, or on a specified rating basis, but never on the basis of loss experience. In other words, the cost is guaranteed to the extent that it will not be adjusted based on the loss experience of the insured during the period of coverage. Contrast with Retrospective Rating.

Hazard

Situation or condition which either causes or increases chances of a peril taking place.

HCFA-1500

Obsolete form from the Health Care Financing Administration. Updated to a Centers of Medicare and Medicaid Services CMS-1500 Health Insurance Claim Form.

HCPCS

(Healthcare Common Procedural Coding System) HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies.

Hearing

The WC law provides that “no case shall be closed without notice to all interested parties and without giving to all such parties an opportunity to be heard.” These “hearings” are held before a WCLJ who hears and determines claims for compensation for the purpose of ascertaining the substantial rights of the parties. (WC law § 20, 150)

Hearing Point

Locations where the WCB holds hearings.

HIPAA

The Health Insurance Portability and Accountability Act of 1996. A law enacted by Congress requiring the U.S. Health and Human Services Department to adopt standards for transmission of information between parties while carrying out financial or administrative activities related to health care. These standards also must address security of protected health information.

Inception Date

The date on which coverage takes effect.

Incurred Cost

The total anticipated ultimate cost of a claim. The incurred cost is the sum of all past payments and a reserve for all future payments.

Indemnity

The act of providing restitution for a loss or claim that has been discharged or paid by another liable party.

Indemnity Benefits

Compensation paid to the Workers’ Compensation claimants for lost time resulting from an injury or illness.

Independent Contractor

One who undertakes to do a specific job and retains control of the means, method and manner of performance.

Indexed Claim

A claim case folder that has been assembled and assigned a case number by the WCB Claims Unit. (WC law § 141)

Information Page

A document issued by an insurance company on a new policy which contains specific information identifying the insured and the coverage afforded. Also known as the Declaration page.

Insurance

A contractual arrangement under which one party agrees to indemnify another against loss or damage from an unknown event for a certain sum called a premium.

Insurance Agent

An insurance agent represents the insurance company and can enter into contractual obligations on the insurance company’s behalf. NYSIF does not have insurance agents.

Insurance Broker

An insurance broker is someone licensed to represent an insurance applicant in the negotiating for insurance. Also see: Authorized Representative.

Insurance Fraud

A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud, presents causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer or purported insurer, or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which he knows to: (i) contain materially false information concerning any fact material thereto; or (ii) conceal, for the purpose of misleading, information concerning any fact material thereto.

Insured

The person or entity to be indemnified by the insurer in the event of a covered loss or damage.

Joint and Several Liability

A condition where two or more persons or legal entities are jointly and severally responsible for an obligation.

Joint Venture

Two or more employers (usually contractors) who associate and collaborate for the purpose of undertaking one or more projects. The projects under taken by a Joint Venture are usually of a limited duration with specified objective(s).

Jones Act

The Merchant Marine Act of 1920 also known as the Jones Act (46 U.S. Code, § 688). This federal law, which is part of Admiralty Law, provides that masters and members of crews of vessels have the right to sue their employers for damages in Admiralty Courts for injuries sustained in the course of employment.

Judge

See Workers’ Compensation Law Judge

Judgment

The final order or decision by a court or referee on a legal action.

Jurisdiction

The WCB has jurisdiction over cases with employment in New York State. Notable exclusions from WCB jurisdiction in NYS include: federal government workers and certain employees of local government. Workers covered by separate compensation systems under federal laws (maritime employment, merchant seafarers, interstate railroad employees, etc.) may elect to submit to NYS jurisdiction by waiving their federal rights and remedies.

Liability

An obligation imposed by law or equity.

Licensed Representative

A person other than an attorney who is authorized by the WCB to represent claimants, or carriers before the WCB. (WC law § 24a, 50-3b, 225, Board Rule Licenses)

Limited Partnership

A partnership formed by two or more persons, having as members one or more general partners and one or more partners limited in his or her obligation for the debts of the firm to the amount of his or her capital contribution and limited in his or her right or power to take part in the control of the business.

Limit of Liability

The maximum monetary sum payable under an insurance policy.

Longshore and Harbor Workers’ Compensation Act

Federal law which provides for payments of compensation and other benefits to employees such as longshoreman, harbor workers, and ship repairers. It applies to such employees while working on navigable waters, adjoining piers, and terminals. It does not cover members of a crew of a vessel. U.S. Code (1946), Title 33 § 901-950.

Loss Cost

The portion of a premium rate that represents the anticipated costs of claims and associated loss adjustment expenses, including one or more trend factors, but which does not include provisions for insurer-specific expenses such as acquisition costs, overhead and taxes, or profit. Loss costs are based on loss data provided by all workers’ compensation insurers and are filed by the rate service organization for workers’ compensation (the New York Compensation Insurance Rating Board) with the New York State Insurance Department.

Loss Cost Multiplier

The portion of the premium rate not included in the loss costs filed by the rate service organization for workers’ compensation (the New York Compensation Insurance Rating Board), which includes insurer-specific expenses such as acquisition costs, overhead, taxes and profit.

Loss Ratio

The losses incurred expressed as a percentage of earned premium.

Loss Reserves

Funds set aside for the payment of losses which have been incurred, but are not yet due.

Lost Time

This is the time lost from work directly related to a workers’ compensation claim. A claimant is not entitled to lost time wages ( Indemnity Benefits) until after the statutory waiting period of seven (7) days.

Lump Sum Settlement

A negotiated and WCB approved agreement between a claimant with a non-schedule permanent partial disability and the insurer(s). As a result of the agreement the claimant receives a sum of money representing all future compensation for his/her disability, and the case is considered closed. WC law §15(5-b)

Managing Agent

A person or organization appointed by the owner of a property (usually a landlord) to act on his or her behalf, usually in collection of rents or maintenance of the property.

Manual Rate Premium

Premium level charged to a risk under a workers’ compensation policy, produced by totaling the product of the classification code rates, by the unit upon which premiums for that code is determined.

Manual Rates

The listed premium, stated as dollars per $100 of weekly earnings for each employee, in a state’s current schedule; in New York the manual rates are linked to the Classification Code system (i.e., rates are stated for each work classification code used in the state).

Maximum Medical Improvement (MMI)

Based on medical judgement the claimant has recovered from the work injury to the greatest extent that is expected and no further change in condition is expected. A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.

Medical Benefits

Medical treatment provided, under the WC law, to injured workers as a result of injuries arising out of and in the course of employment.

Medical Fee Schedule

The schedule established by the WCB Chair of charges and fees for medical treatment and care furnished to workers’ compensation claimants. (WC law § 13, Sub. A)

Medical Treatment

Care (other than first aid) administered by a physician, chiropractor or podiatrist or on a physician’s referral, by a psychologist, or physical or occupational therapist.

Minimum Premium

The least amount required in order for a policy to be issued.

Motion Calendar Hearing

The Motion Calendar has been replaced by the Administrative Decision process. A Motion Calendar case was previously a case with no controversy or outstanding issue.

Named Insured

The person or entity named in a policy as being protected by such policy.

National Council on Compensation Insurance (NCCI)

An association of WC insurers which serves as the WC rating organization in about two-thirds of the states. The group establishes standards for use in rate making, develops policy forms, collects statistics, and provides statistical support and services.

National Drug Code

The National Drug Code (NDC) is a unique code that identifies the vendor (manufacturer), product and package size of a drug recognized by the Food and Drug Administration.

National Institute for Occupational Safety and Health (NIOSH)

An agency within the U.S. Department of Health and Human Services. Part of the Center for Disease Control and Prevention and is generally responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries.

National Provider Identifier (NPI)

Standard unique identifier that must be used by health care providers for electronic health care transactions covered under HIPAA.

Negligence

An act or omission in which there is a failure to use the ordinary care that a prudent person ought to use under the circumstances. Negligence can cause or create a legal liability.

New York Compensation Insurance Rating Board (NYCIRB)

An association of workers’ compensation insurers licensed by the Superintendent of Insurance as the rate service organization (RSO) for workers’ compensation in New York. It collects and analyzes loss data and, as the designated RSO, files loss costs with the Insurance Department for rate making purposes. It also administers experience rating and classifications of employers for determining premium. As RSO for workers’ compensation, NYCIRB is governed by a board of nine voting members including four representing private insurers writing workers’ compensation insurance, one NYSIF representative, a member appointed by the Superintendent of Insurance and one member each, subject to the approval of the Superintendent of Insurance, appointed by the Workers’ Compensation Board, the Business Council of New York State, and the New York State AFL-CIO.

No Compensable Lost Time (NCLT)

Claimant has not lost time from employment beyond the statutory waiting period (the first seven days of disability) as a result of work related injuries. (WC Law § 12)

No Further Action (NFA)

A decision of no further action (NFA) is based on a WCLJ determination that no issues need to be adjudicated by the WCB at the time of the finding. If or when further WCB action is required, a hearing must be requested by one of the parties to the claim.

No Lost Time (NLT)

Claimant has not lost time from employment beyond the date of the accident as a result of a work-related injury. (WC Law § 12)

Non-Insurer

An employer who has failed to provide for the payment of benefits to employees under the WC law or under the Disability Benefits law. (WC law § 50, 220)

Notice (VFFBL & VAWBL)

Under the Volunteer Firefighters’ Benefit Law and the Volunteer Ambulance Workers’ Benefit Law, notice of injury or death must be given by the injured volunteer firefighter or ambulance worker or dependents within 90 days after the injury or death.

Notice (WC Law)

Employees who are injured on the job must give their employers notice in writing of the occurrence as soon as possible but not later than 30 days thereafter. The WCB may excuse the failure to give notice on the ground that notice for some sufficient reason could not have been given on the ground that the employer had knowledge of the accident or on the ground that the employer had not been prejudiced thereby. In addition, a claim must be filed with the WCB within two years. Failure to file a claim may bar an award of compensation unless the employer has made advance payments to the injured worker or has failed to raise the issue at the first hearing at which all parties were present. (WC law § 18, 28, 40, and 45)

NYCIRB

See New York Compensation Insurance Rating Board

NYSIF Claim Number

NYSIF’s carrier case number also known as a claim number or loss id (e.g. 12345678 – 123 ). The last three numbers is typically the NYSIF claim unit handling this claim.

Occupational Disease (OD)

A disease arising from employment conditions for a class of worker, with the disease occurring as a natural incident for particular occupations, distinct from and exceeding the ordinary hazards and risks of employment. To be considered an occupational disease, there must be some recognizable link between the disease and some distinctive features of the worker’s job. (WC law § 2 (15), 3(2), 37)

OSHA

Occupational Safety and Health Act of 1970. Under this federal law, the US Department of Labor has responsibility of formulating safety and health standards for all businesses engaged in interstate commerce. www.osha.gov

Partial Disability

Disability which allows a claimant to engage in some kind of gainful employment. The difference between the claimant’s pre-accident earnings and post-accident earnings is determinative of the reduced earnings rate. (WC law § 15, Sub.5, 5-a)

Party of Interest (POI)

The claimant (claimant’s attorney), employer (employer’s representative) , medical provider, carrier and may also be any statutory fund that may be liable in the particular case.

PBM

See Prescription Benefits Manager

Permanent Partial Disability (PPD)

Part of the employee’s wage-earning capacity has been permanently lost on the job. Benefits are payable as long as the partial disability exists, except for schedule loss of use. If there are no reduced earnings as the result of the partial disability, only medical benefits are payable.

Permanent Partial Disability (PPD) Cap

The maximum number of weeks of compensation, from 225 to 525, that a claimant classified as PPD may receive, based on percentage finding of lost earning capacity. The cap applies only to non-scheduled PPD cases with a date of accident on or after March 13, 2007.

Permanent Partial Disability (PPD) Extreme Hardship

An Extreme Hardship redetermination may be made in a capped PPD case where the claimant was classified with a finding of lost earning capacity which exceeds 80%. The claimant may request a reclassification at the WCB for a Permanent Total Disability (PTD) or Total Industrial Disability (TID). (WC Law § 35)

Permanent Total Disability (PTD)

The employee’s wage-earning capacity is permanently and totally lost. There is no limit on the number of weeks payable. In certain instances, an employee may continue to engage in business or employment, if his/her wages, combined with the weekly benefit, do not exceed the maximums set by law.

Physical Hazard

A physical hazard is a feature in the construction, maintenance, use or condition of a work location that creates the possibility of an accident.

Policyholder

A party to whom a policy is issued, and who pays a premium to an insurer in consideration of the latter’s promise to provide insurance protection.

Policy Number

The number that is assigned to your insurance policy.

Policy Year

The year commencing with the effective date of a policy or with the renewal date of that policy, to be distinguished from calendar year, which always starts January 1.

PPD

See Permanent Partial Disability.

PPO

See Preferred Provider Organization.

Pre-Existing Condition

Injuries, sickness or medical conditions existing prior to the injury or onset of the occupational disease.

Preferred Provider Organization (PPO)

Network of medical providers that renders services (at contracted rates) for the treatment of workers’ compensation injuries and illnesses to employees of participating policyholders.

Pre-Hearing Conference

If a case is controverted, the WCB must schedule a pre-hearing conference before a WCLJ judge within 60 days of the receipt of notice of controversy from carrier or employer. This hearing is for the purpose of identifying witnesses, limiting issues and, if possible, to establish the case upon the agreement of the parties

Premium

The rate that an insured is charged reflecting their expectation of loss or risk.

Prescription Benefits Manager (PBM)

A network of pharmacies and mail order services under the direction of an organization, which provide prescription benefits under contract or agreement with a carrier or employer.

Primary Insurance

Insurance that responds first to a claim (i.e., it provides coverage on a first-dollar basis), sometimes subject to a deductible.

Professional Employer Organizations (PEO)

Professional Employer Organizations (PEOs) are employee leasing firms that provide long-term or ongoing employee leasing to client businesses. PEOs must be registered with the New York State Department of Labor in accordance with Article 31 of NYS Labor Law.

Protection and Indemnity Insurance

Broad form of marine liability insurance that covers the operator of a ship for such things as liability to crew members and other individuals on board the vessel, and for damage to fixed objects, such as docks, resulting from the insured’s negligence.

Protracted Healing Period

In the case of temporary total disability and permanent partial disability both resulting from the same schedule injury, if the period of temporary total disability continues for a longer period than the normal healing period as set forth in WC law §15, Sub. 4-a, the period of temporary total disability in excess of such normal healing period is added to the schedule award. (WC law §15, Sub. 4-a, WC law and § 9, VFBL and VAWBL)

Rate

Cost of insurance per unit used as a means or base for the determination of premium.

Rate Service Organization (RSO)

A Rate Service Organization (RSO) is an entity designated by the Superintendent of the New York State Department of Insurance for the collection and analysis of workers’ compensation data.

Rating Date

The anniversary rating date is the effective month and day of the policy in effect and each annual anniversary thereafter unless a different date has been established by the Rating Board. Normally the anniversary rating date is the same as the policy effective date. However, the rating date can be different from the policy effective date, e.g., if a policy has been short termed on an experience rated policy for which the rating date remains the same. The rating date determines which rates are to be applied for a given period regardless of the policy anniversary date.

Reduced Earnings (RE)

A compensation rate based on the claimant’s reduced earning or reduced earning capacity due to a condition related to a compensable injury (WC law § 15).

Rehabilitation

The process of restoring injured workers to productive employment through physical means, medical procedures, vocational retraining, selective placement, and social readjustment. Rehabilitation is an integral part of the medical care and other services furnished a claimant under the law. (WC law §13, Sub. a)

Remarriage Award

An award of two years’ compensation paid in a lump sum, to the surviving widow or surviving widower of a fatally injured worker upon his or her remarriage. (WC law § 16, Sub. 2)

Renewal

A document issued by an insurance company extending the terms of a policy for a subsequent period of time. It reestablishes the in-force status of a policy. All NYSIF policies with in-force status are automatically renewed unless instructed otherwise by the policyholder or their representative.

Reopened Case

A case that has been closed by a WCLJ or the WCB, and is subsequently made active again to determine the claimant’s eligibility for benefits. (WC law § 22, 23, and 224)

Rescind (a Decision)

A WCB Panel memorandum of decision which voids or annuls a WCLJ decision. Decisions to rescind are usually issued without prejudice in order to allow the parties to present evidence or testimony not previously presented to a WCLJ.

Reserve

The amount of money set aside to pay the potential future cost of a claim.

Retrospective Rating

An insurance plan for which the final premium is not determined until the end of the coverage period and is based on the insured’s own loss experience for that same period.

Risk

The entity, property or other exposure to be insured. Also used to signify uncertainty about financial loss.

Return to Work (RTW)

A Return to Work program is a written plan designed to get employees back to work as soon as medically possible following an on-the-job injury or illness, and can be initiated by either the employer or the carrier. It is mutually beneficial to both employees and employers.

Safety Group

Safety Group is a loss sensitive insurance program that enables employers in the same industry to pool their insurance premiums with the goal of reducing the cost of workers’ compensation insurance.

Schedule Award

An award made by the WCB when the claimant suffers the loss of use of an extremity, sight, hearing, or facial disfigurement, regardless of lost time. A table of scheduled awards, listing body parts and percentage of loss, is used to determine the number of weeks of compensation. (WC law §15, VFBL §10, VAWBL §10)

Scheduled Loss of Use (SLU)

Permanent physical or functional impairment to an extremity, loss of hearing or sight, or in a facial disfigurement.

Schedule Loss

The number of weeks of compensation payable for permanent partial disability due to the loss of use of certain members of the body or organs as listed in WC law § 15, VFBL § 10, VAWBL § 10.

Second Injury Fund

Unofficial name for the Special Disability Fund established to encourage employers to hire workers with physical handicaps. When workers with pre-existing conditions suffer further work-related injuries, or disease, that results in a greater disability, the employer, through the insurer, is responsible for only part of the benefits. The Second Injury Fund is responsible for the rest (WC law § 15, Sub. 8). This provision no longer applies for loss dates after June 30, 2007.

Second Injury Law

This law is designed to encourage the employment of people with disabilities by limiting the liability of an employer in the event of the injured worker sustaining a permanent disability due to work connected injury. (WC law § 15, Sub. 8)

Section 32 Settlement

WC Law § 32 Waiver Agreement. § 32 waiver agreements allow for complete, full and final resolution of a WC claim.

Self-Insurance

A method by which an employer or group of employers may secure the payment of workers’ compensation or disability benefits for its employees by depositing securities, cash, letters of credit or a surety bond in an amount required by the WCB Chair. (WC law § 50, § 211)

Short Rate Cancellation

Termination of a NYSIF WC policy before its normal expiration date which in turn causes a refund of premium which is less than that which would ordinarily be due to the insured for the proportion of time that coverage was in force.

Sole Proprietorship

Individual ownership of a business or other institution.

Special Funds

Funds established under the WC law to assure payments of benefits associated with claims, usually by transferring all or part of the liability to Special Funds. (WC law § 15-8, § 25-a, § 15-9, § 25-b, § 26-a, § 107, § 214 and § 319)

Special Funds Conservation Committee (SFCC)

The Special Funds Conservation Committee was established in 1938 for the purpose of maintaining and defending the Special Disability Fund and the Fund for Reopened Cases under § 15-8 and § 25-a of the Workers’ Compensation Law.

Subcontractor

An individual or business firm contracting to perform part of or all of another’s contract. See Independent Contractor, General Contractor.

Subpoena

A legal writ commanding a designated person to appear and give testimony at a compensation hearing under penalty for failure to do so. The Chair, Board Members, Judges, officers of the WCB designated by the Chair and any attorney may sign and issue a subpoena, or a subpoena duces tecum, the latter requiring the production of records. (WC law § 119, 142 -3, 231)

Subrogation

The right of a secondary party (e.g., insurance company) to stand in the place of another (e.g., a policyholder or claimant) after making payment to a creditor (e.g., claimant) to enforce the creditor’s right against the party primarily liable for such payment in order to obtain indemnity from such primary party.

Symptomatic Treatment

Medical treatments aimed at providing relief from the symptoms of a disease or injury, rather than providing a permanent remedy to the underlying condition.

Temporary Partial Disability (TPD)

The wage earning capacity is lost only partially, and on a temporary basis.

Temporary Reduced Earnings (TRE)

A temporary reduced earnings rate of compensation pending adjudication of the actual amount of reduced earnings or the determination of the claimant’s reduced wage earning capacity.

Third Party Action

In workers’ compensation cases, the term often refers to lawsuits against parties such as equipment manufacturers, facility owners and other non-employer entities whose products or services contributed to the occurrence of an accident.

Third Party Administrator (TPA)

An independent organization that has been contracted to administer identified services. These services may include claims administration, premium collection, enrollment and other administrative functions.

Third Party Settlement

When a claimant’s work related injury is the result of negligence or wrongdoing of a party other than the employer or a fellow employee, the claimant may sue. A carrier that has paid compensation or disability benefits has a lien on any sums recovered in a third party action. (WC law § 20, 29, 227 and VFBL and VAWBL)

Total Disability

No wage earning capacity. (WC Law § 15, Sub. 1,2)

Total Industrial Disability (TID)

Complete loss of earning capacity due to claimant’s permanent partial disability. This is based on medical factors, combined with other vocational factors (such as limited education), which render the claimant incapable of any gainful employment.

Trade Name

The arbitrarily adopted name under which an organization conducts business.

Trial Calendar Hearing

A regularly scheduled hearing on a case conducted by a WCLJ that is designed to permit the introduction of evidence and/or witnesses and the presentation of arguments by the parties.

Underwriter

The person authorized by an insurance company to bind coverage and make changes to policy terms.

Uninsured Employers’ Fund (UEF)

A special fund that provides for the payment of workers’ compensation in cases where the employer was not insured or self insured. (WC law § 26-a)

VESID (Vocational Educational Services for Individuals with Disabilities)

A division of New York State Education Department providing services for individuals with disabilities. www.vesid.nysed.gov

Voluntary Compensation

An addition to a workers’ compensation policy that covers benefits to employees who are not required to be covered by a state’s WC law.

Volunteer Ambulance Workers’ Benefit Law (VAWBL)

 

WC Law Chapter 64-B provides medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for volunteer ambulance workers. (WC law chapter 64-B)

Volunteer Firefighters’ Benefit Law (VFFBL)

WC Law Chapter 64-A provides medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for volunteer firefighters. (WC law chapter 64 – A)

WA-1 (Work Activity Form)

A NYSIF form periodically sent to claimants requesting certification of current employment status and continued entitlement to worker’s compensation benefits.

Wage Expectancy

The wages of a claimant who is under the age of 25 when the accident occurs are presumed to increase under normal conditions. The WCB may consider this fact in establishing the claimant’s compensation rate if the injuries are permanent. (WC law § 14, Sub. 5)

Wage Replacement

The proportion of pre-injury wages replaced by workers’ compensation benefits.

Wages

The money rate at which employment with an employer is recompensed under the contract of hiring with the employer and shall include the reasonable value of board, rent, housing, lodging or similar advantage received under the contract of hiring. (WC law § 2, Sub. 9, § 201, Sub. 12)

Waiting Period

Period covering the first seven days of disability resulting from a work-connected injury or illness. Workers’ compensation indemnity benefits are not allowable for the first seven days of disability, except in cases where the disability period exceeds 14 days, indemnity awards are allowed from the date of disability (WC law § 12, § 204 and § 211). There is no waiting period for VAWBL and VFBL cases (WC law § 43, VFBL, and VAWBL).

Waiver Agreement Management Office (WAMO)

The 2007 Workers’ Compensation Reform Act established a Waiver Agreement Management Office (WAMO) under the supervision of the chair of the Workers’ Compensation Board. WAMO will be dedicated to expediting Section 32 Settlements on §15-8 (Second Injury) established cases, pursuant to WC Law.

Waiver of Subrogation

A voluntary release or relinquishment of a right of action (e.g., right to sue) on behalf of another.

WCB Case Number

A reported work injury or illness, which has been assembled and assigned a case number (indexed) by an indexing unit of the WCB.

WCB Examiner

Workers’ Compensation Board Examiner performs examining work, applying knowledge of WC law and of WCB rules, regulations, policies and procedures to compensation and disability benefit case information. Among the actions regarding workers’ compensation cases that examiners may perform are:

· determining whether a case should be indexed;

· evaluating claim forms and developing information required by judges for case decisions;

· requesting information (by phone, letter, etc.) needed for case development;

· evaluating whether a compensation case may be processed on an informal calendar;

· referring appropriate cases to the conciliation process; and

· preparing formal notices of decision based on judge’s directions.

Without Prejudice

The term implying employers or their insurance carriers may provide non-binding compensation or medical payments, including payments for medication, for up to one year without admitting liability or giving up specific legal rights.

Workers’ Compensation Board (WCB)

A state agency, the Workers’ Compensation Board administers the provisions of the NYS WC law, including: the Workers’ Compensation Law; the Disability Benefits Law; the Volunteer Firefighters’ Benefit Law; the Volunteer Ambulance Workers’ Benefit Law; and the Workers’ Compensation Act for Civil Defense Volunteers on behalf of injured workers and employers.

Workers’ Compensation Insurance

New York State Workers’ Compensation insurance provides injured workers with medical and compensation benefits or, in the case of death, death and survivor benefits to their dependents for on-the-job injuries.

Workers’ Compensation Insurance Rates

Rates are determined by the New York Compensation Insurance Rating Board (NYCIRB) and published in the Rating Board Manual. These rates are usually per $100 of payroll, with the rate being determined by job classification. There are several classifications, however, where the rate is not on a payroll basis, but rather on a per capita, per location, population or per policy.

Workers’ Compensation Law

Chapter 67 of the Consolidated Laws, governing the workers’ compensation system; separate laws cover compensation benefits for volunteer firefighters and volunteer ambulance workers.

Workers’ Compensation Law Judge (WCLJ)

An officer appointed by the WCB Chair to hear and determine claims and to conduct hearings and investigations and make such orders, decisions and determinations as may be required in the adjudication of the claim. A Judge’s decision is deemed the decision of the WCB unless the WCB modifies or rescinds such decision.

Workers’ Compensation Professional (WCP)

The American Society of Workers’ Comp Professionals, Inc., ( AMCOMP) developed an education program, Workers’ Compensation Professional (WCP), to help raise professional standards in the field of workers’ compensation. The WCP designation signifies that an individual has completed a rigorous workers’ compensation curriculum and successfully passed course examinations demonstrating a broad-based knowledge and understanding of workers’ compensation.

Wrap-up Insurance

A policy that covers all exposures for a large group that has something in common. For example, wrap-up insurance is written for all the various businesses working together on a particular project, to provide coverage for losses arising out of that work only.