Secondary
Glossary of Workers Compensation Terms
GLOSSARY OF WORKERS' COMPENSATION TERMINOLOGY
AA
Applicant's Attorney, IW's legal representative
ACTIVITY CHECK
A canvas of the neighborhood conducted by an investigator to determine the extent of the employee's daily activities. Usually conducted prior to authorizing subrosa.
ADA
Americans with Disabilities Act
AGE
The age of the claimant at the time of the injury.
AOE/COE
Arising Out of Employment / In the Course Of Employment (Generally associated with disputed claims)
AME
Agreed Medical Examiner / Agreed Medical Evaluator Used to resolve medical and permanent disability issues.
AME
Agreed Medical Evaluator - Medical examiner qualified to render an opinion on a work-related injury that is selected by the employee and employer from a panel of three examiners presented to the injured employee by the W/C carrier
AOE
Arising Out of Employment - Term used to describe injury or illness to an employee that results directly from the employment activity and may be compensable under Workers' Compensation.
APPORTIONMENT
Allocation of a portion of a disability as a result of an aggravation to a pre-existing condition. Reducing the employer's liability by a percentage of the disability that can be attributed to a prior injury.
AWE AWW
Average Weekly Earnings
Average Weekly Wage - Amount used to determine indemnity award for Workers' Compensation
Cal/OSHA
CE
CLAIMANT
California's version of federal OSHA (Occupational Safety & Health Act.
Case Estimate (projected financial exposure)
The person filing a claim form, the injured worker.
CLAIMS COMPENSABILITY
Admission or acceptance that the injury is work-related. A compensability investigation is conducted to determine if an accident occurred, whether the employee was in the course and scope of his /her employment when the injury occurred and whether the employee sustained an injury or illness that was caused by a work related incident.
CLAIM FORM
C&R
COE
CT
CTD
The DWC-l form for recordable injuries:
. Establishes jurisdiction
. Satisfies statute of limitations
. Permits discovery
. Allows lien claimant to file an application
. Must be filed within 1 year from the DOI or last
activity.
Compromise and Release
Settlement arranged between parties of a W/C claim, and approved by WCAB. Settlement documents filed by both parties for a lump sum payment and releasing all claims. Not applicable if claimant remains employed. (See STIP)
Course of Employment
Term describing injuries to employees in connection with the job, including commuting between job sites or other activities not directly related to job tasks
Cumulative Trauma (e.g. carpal tunnel, stress, repetitive motion)
Cumulative Trauma Disorder - Term describes injuries caused by stress of repetitive motion in job duties. (e.g. tendonitis, carpal tunnel)
DEFENSE ATTORNEY
Represents insurance carrier and employer.
DEPOSITION
A hearing, usually at the office of the employee's attorney, where the claimant and his/her attorney, and the carrier are
present. The employer's attendance is highly recommended yet optional.
DEU
Disability Evaluation Unit - State agency that rates medical reports for PD.
DISCLOSURE STATEMENT
Document signed by the claimant wherein he/she appoints an attorney to represent him/her. Once received, the employer may no longer discuss claim related matters directly with the employee.
DOCTOR'S FIRST REPORT OF INDUSTRIAL INJURY
Initial report prepared by the treating doctor, due within 5 days of examination.
DOI
Date of Injury
Relates to injuries on-the-job that are filed as Workers' Compensation claims
DOK
Date of Knowledge of the injury
Date on which employer became knowledgeable of an employee injury that is compensable under Workers' Compensation and used to determine if penalties are due to the employer for failure to comply in timely manner
DOR
Declaration of Readiness to Proceed a.k.a. Application for Adjudication. Document filed in order to get a hearing date before a WC referee. Notice given to Workers' Compensation Appeals Board that parties are ready to proceed, and request the matter be placed on the court's calendar
DWC-I
Employees' WC claim form.
DWC
Division of Workers' Compensation. State agency within DIR that administers and enforces provisions of the Labor Code relating to Workers' Compensation
EMPLOYER'S REPORT OF INDUSTRIAL INJURY a.k.a. Form 5020 Completed by employer and sent to the insurance carrier within 24 hours of claim; or form generated by the carrier subsequent to the employer calling an (800) number to report a claim.
ERGONOMICS
The science of fitting the environment to the worker. Ergonomics can include providing special materials or equipment, redesigning workstations, and changing the job requirements and any other activity that reduces the likelihood of cumulative trauma injury.
FINDINGS AND AWARD
Set by the WC referee (judge) as a result of a hearing (trial). An objection to the ruling must be filed within 20 days when both parties are not in agreement. An order issued by an Administrative Law Judge when a Workers' Compensation claimant receives an award
FIRST AID
A non-recordable injury as defined by OSHA.
F&O
Finding and Order
An order issued by the Administrative Law Judge when a Workers' Compensation does not receive an award
FME
Formal Medical Evaluation - Evaluation required when employer claims there is no permanent disability under a case for work-related injury and the employee makes a request for another opinion on the matter
FREQUENCY
The rate of occurrences of workplace injuries.
GOING & COMING RULE
Injuries that occur during travel to and from work are not compensable unless it can be established that the employee was on company business (see Special Errand).
HEALTH CARE ORGANIZATION (HCO)
Employers who offer employees two or more certified Health Care Organizations (HCOs) must provide employees a Personal Physician Designation Form at the time of employment and at least annually thereafter only upon request. Otherwise employers must provide it only upon a request by the employee.
HEARING NOTICE
A copy of notice of hearing in workers' comp claim court.
HEARING REPRESENTATIVE
A non-licensed attorney that handles lower volume uncomplicated WC cases for the insurance carrier.
IMC
Injury Management Coordinator
IMC
Industrial Medical Council
A 14-member panel of physicians appointed by the Governor and the Legislature to deal with medical issues that arise out of the Workers' Compensation system
IME
Independent Medical Examiner
A physician, other than the treating physician, that gives an "unbiased" opinion.
INCURRED
The amount paid plus the amount reserved that represents what the case will ultimately cost.
INDEMNITY
The portion of workers' compensation losses relating to wage replacement, permanency and other case benefits.
INDEPENDENT CONTRACTOR / SUB-CONTRACTOR
Non-employee not covered under the Company's WC policy, unless the contractor fails to carry insurance.
INSURED
The employer
IVE
Independent Vocational Evaluator
Person qualified under Labor Code 4635 (c) in rehabilitation because of the educational degree or certification to develop rehabilitation plans. Used when both parties are unable to agree upon choice of a vocational counselor.
IW
Injured Worker a.k.a. The Claimant (See QIW)
JA
Job Analysis, Job Description, Job Functions (See JF A)
JFE
Job Function Evaluation a.k.a. Job Analysis, Job Description
JFA
Job Function Analysis
A detailed description of the manual aspects of a position (See JF A)
LAG TWE
Amount of time between the accident and the time it is reported to the insurance company. Delaying the report may default to an acceptable claim.
LOSS EXPERIENCE
The loss record of an insured - indicated by the frequency (number) and severity (dollar costs) of the workplace injuries. (See X-MOD)
LOSS RUN
A monthly report from the insurance carrier, providing the number of claims, type of injury, body part, medical costs, and indemnity reserves.
LTI
Lost Time Injury
When the injured employee fails to return to his/her next regularly scheduled workday.
MAXIMUM COMPENSATION RATE
The maximum weekly compensation rate as established by the State. Although an employee's average weekly wage may exceed this amount, the pre-determined compensation rate cannot be exceeded.
MEDICAL MANAGEMENT or MEDICAL CASE MANAGEMENT
The coordination of medical care and services at a reasonable rate. Usually implies the use of a PPO, and a nurse case manager. Involving a health care professional, usually a nurse, in the management of a workers' compensation case. This person usually offers medical expertise and a non-adversarial viewpoint and helps ensure that the injured employee receives quality, cost-effective medical treatment.
MED-LEGAL
Medical report offered into evidence by the parties. Both sides can have their own report.
MEDICAL ONLY An industrial accident that results in medical costs only with
no compensable lost time from work.
MITIGATE
To lessen, decrease or lighten.
MODIFIED DUTY
a.k.a. light duty. A temporary assignment to accommodate
work restrictions, pending full medical release. It's better to
refer to this as Transitional Duty, to avert ADA problems.
MSC
Mandatory Settlement Conference
Where the parties attempt to resolve the claim in an informal manner, with or without attorneys. When an Application for Adjudication is filed with WCAB the conference must be held within 30 days to attempt to resolve the dispute before a regular hearing is scheduled with the WCAB.
MSDS
Material Safety Data Sheet
They contain information on chemicals of potential hazards, and personal protective equipment requirements. MSDS' s must be accessible to employees.
NATURE & EXTENT
The kind or type and magnitude of the injury.
NLT
Not a Lost Time case
NUISANCE VALUE
Settlement of a case for a few dollars in order to get rid of it.
Cheaper than fighting the claim. The amount is referred to as being of nuisance value.
OBJECTIVE
Direct medical substantiation, e.g., x-ray, cat-scan.
OCCUPATIONAL DISEASE
A condition such as asbestosis or silicosis
OSHA
Federal Occupational Safety & Health Act
P&S
Permanent and Stationary
The point at which the treating doctor claims that the employee's condition will get no better or no worse. Term used to describe the determination of a W/C physician that the condition due to injury will not change as the result of continued medical treatment
PD
Permanent Disability
A physical condition is considered permanent after the employee has reached maximum medical improvement, and the condition has been stationary for a reasonable period of time and not expected to change in a lifetime
PDA
Permanent Disability Advance
Monetary advances made to the QIW that are reduced from the final settlement.
PDR
Permanent Disability Rating - Rating given an employee for injuries causing disability in one of 100 standard disabilities beyond the point the employee is designated as permanent and stationary
PPD
Permanent Partial Disability
(Requires a PD rating of 99 3/4% or less)
Term used to describe an award for an injury that has limited the employees' ability to perform "usual work" where the condition is not expected to change or improve
PERMANENT DISABILITY RATING
A quantified evaluation of the PD issued by the State.
PPO
Preferred Provider Organization
PROVIDER
Doctor or facility providing care, therapy, etc.
PTD
Permanently Total Disability (rating of 100%)
Benefits stop at death and accrued benefits go to dependents or heirs.
PWCJ
Presiding Workers' Compensation Judge - Has administrative responsibilities for the WCAB field offices and assigns W IC cases to the trial judges in that office
QIW
Qualified Injured Worker
Unable to return to previous occupation. Applies to employee's usual and customary occupation. Potentially eligible for VR if medically eligible and VR feasible. Term that describes an injured employee who meets the requirement of being both medically eligible and vocationally feasible under Labor Code 4635(a)
QME
Qualified Medical Examiner I Qualified Medical Evaluator Physician who devotes the majority of their practice to medical treatment of work related injuries and is certified by the IMC to render an opinion that will be held enforceable by WCAB
QRR
Qualified Rehabilitation Representative
Person capable of developing and implementing a vocation rehabilitation program and whose duties regularly involve evaluation, counseling or placement of a disabled person under Labor Code 463 5(b)
QRS
Qualified Rehabilitation Specialist
QUARTERLY CLAIMS REVIEW
Examination of claims, by employer, insurance broker
& carrier, normally conducted every 3 months.
REASONABLE ACCOMIDATION
An accommodation, as defined under the ADA, that does not create an undue hardship to the employer ill terms of safety, efficiency, or financial costs. If the accommodation is reasonable, it must be made in order to allow a qualified disabled applicant to undertake the work, or an employee with PD resulting from job related injury or illness to continue his/her employment.
REASONABLE & CUSTOMARY .
Determination as to whether services, procedures, and charges are appropriate and necessary. (See Usual & Customary)
RECORDABLE
An injury meeting OSHA guidelines as recordable and requiring an entry onto the OSHA Log 200.
REHABILITATION PLAN
Plan formulated by the carrier and approved by employer to establish VR goals and time frames. ($16k cap ill California) Employer may offer work ill lieu of VR if it pays not less than 85% of wages at time of injury and lasts for at least one year.
REPORTABLE
A serious injury requiring the employer to report it to Cal/OSHA within eight (8) hours of the event.
RESERVES
An amount estimated and allocated by the carrier to be spent in the future ill order to close the claim.
RETRAINING
Process of retraining a QIW for new occupation, usually through Voc-Rehab
RTRW RTW RTWP
Released To Return to Work
Return to Work
Return to Work Program
Temporary modified work (transitional duty) that is offered to an injured employee who has not achieved full recovery and is temporarily partially disabled.
RU-91
A workers' comp form for a job description of the employee's duties. a.k.a. Job Function Analysis.
SELF PROCURED
Medical services obtained by an IW without the consent of the employer or the carrier.
SERIOUS & WILLFUL
Severe and intentional misconduct cause by the employer. An egregious act.
SEVERITY
The degree of seriousness. The severity of a claim indicates the dollar amount expected to be paid as a result of a workplace injury.
SIU
Special Investigative Unit, a department within the insurance carrier that specializes in fraud cases.
SKIN & CONTENTS
Tongue-in-cheek remark for claims where the employee says he's injured from head to toe.
SPECIAL ERRAND
An exception to the Going and Coming Rule, e.g., when the receptionist is told to take the mail to the post office on the way home after work.
STIP
Stipulation
When the IW is still employed with the insured and unable to settle the future medical care via a C&R. Also referred to as Stipulation and Award.
SUBJECTIVE
The employee's opinion or perception of his ailment, which the doctor is unable to substantiate.
SUBROGATION The substitution of one person or entity for another, with reference to a claim. Recovery of claim costs from a responsible third party.
SUB-ROSA
Intended to be secret, private, & confidential. In WC it generally implies videotaping a claimant and having him/her under surveillance.
SURVEILLANCE (See sub-rosa)
ID
Temporary Disability
Usually refers to the payments made to an IW while his/her doctor has placed him/her off work. Within Workers' Compensation this term describes the determination that an injury to an employee preventing him/her from performing "usual work" will subside after a course of medical treatment or a period of healing
TENS UNIT
Transcutaneous Electrical Nerve Stimulator
A battery operated, portable electrical pulse generator claimed to reduce the pain of an injury.
TIMELY NOTICE OF LOSS
Prompt submission (within 24 hours). of Employer' s Notice
of Industrial Injury (5020) to the carrier. .
TPA
Third Party Administrator
An organization that processes claims, much like an insurance carrier, for self-insured employers. Contractor hired to administer self-insured benefits plans for employers
TRANSFERABLE SKILLS
Determining which, if any, skills could enable IW to perform a different job.
TREATING DOCTOR
Doctor on record as having medical control.
TTD
Temporarily Totally Disabled
Refers to an incapacity to do any kind of work; temporary partial disability indicates a condition that allows an employee to do some occupational functions
USUAL & CUSTOMARY
The prevailing fee charged by physicians in a geographical area for medical services and surgical procedures. (See Reasonable & Customary)
VENUE
The appropriate location for holding the hearing when considering the residence of the parties and witnesses.
However, the Applicant's Attorney usually picks a location to suit his own needs.
VF
Vocational Feasibility
Term describing conditions where an employee can reasonably be expected to return to suitable, gainful employment, through provisions of a vocational rehabilitation program as outline in LC 4635(a)(2)
VOC-REHAB
Vocational Rehabilitation
Process of returning a QIW to suitable work at the earliest possible time commensurate with their physical and psychological condition, and their social and vocational usefulness. Training provided at the employer's expense.
VRMA
Vocational Rehabilitation Maintenance Allowance
(Formally known as VR TD Vocational Rehabilitation Temporary Disability)
VRU
Vocational Rehabilitation Unit
Formerly known as the Rehabilitation Bureau, this unit within the Office of Benefits Determination has the duty to foster, review and approve vocational rehabilitation plans
WAITING PERIOD
The period of time (the first 3 days of lost time) when the IW receives no TD benefits, unless he's hospitalized.
WC
Workers' Compensation
Term used to describe an insurance program to pay for wages and treatment of employees who experience on the
job related injury or illness
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