Glossary of Terms

 

Incurred but not reported (IBNR) - An insurer's estimate of costs associated with claims that have not yet been submitted for payment, based on studies of prior lags in claim submissions. Used to set claim reserves.

Indemnity - In workers' compensation, the benefit paid to replace lost wages; generally a tax-free replacement of two-thirds of the pre-disability wage, up to a dollar maximum.

Independent medical evaluation - A medical examination carried out by a physician other than the one treating a claimant; used to collect additional medical or functional capacity information, verify diagnoses and treatment plans, determine continued benefit eligibility, and resolve disputes relating to disability or workers' compensation claims.

Individual disability plan - A type of coverage sold directly to individuals by insurance companies and other financial institutions. A statement of health is typically required; premiums are usually age-sensitive; and benefits are based on the selected Plan design and level of payment.

Injury - A bodily injury that is the direct result of an accident and not related to any other causes that occurred after the effective date of the policy.

Insured - Any person covered under a plan.

Integrated benefits - A system whereby the claims processing, payment, case management, information management, and return to work functions of sick pay/salary continuance, STD, LTD, and WC are integrated in order to achieve administrative savings and optimal return-to-work outcomes. The integration is typically achieved through a central administrative function managed by the employer but insurer and TPA based programs have gained popularity in recent years. Increasingly, group health benefits are also being included in integrated benefit designs.

International classification of diseases, ninth edition [Clinical Modification] (ICD-9-CM) - A list of diagnoses and identifying codes used by physicians and other health care providers. The coding and terminology provide a uniform language that permits consistent communication on claim forms.

 
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