
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.