Useful vocabulary for injured workers dealing with the Workers Compensation System
In some instances, the treating physician may report that an injured worker will more than likely not be able to return to normal permanent work. When this occurs, the employer has the option to offer the injured worker alternative work. The new position must be offered for 12 months in length and must also be 85 percent of the wage previously earned. Some times this alternative position must be at a new location. The new locations must be within a reasonable commuting distance from where the injured worker lived at the time of the injury.
Average Weekly Wage (AWW)
The Average Weekly Wage (AWW) equals the average amount of money an employer paid an injured employee for the 13 weeks before an injured employee had to miss work because of an injury or illness. Income and death benefit payments are also based on an injured employees AWW.
Cumulative Trauma (CT) Injury
Cumulative Trauma occurs from an injury that develops based on repeated events or repeated exposures at work. Carpal Tunnel is a common example of this type of injury as is hearing loss due to repeated exposure to constant loud noise.
The Claim employer is the employer for whom the injured employee was working for at the time the injury occurred. This is who the workers compensation claim should be filed through.
Date of Injury (DOI)
The date of injury seems like a fairly straight forward term, but it can be much more complex depending upon the type and severity of the injury. If the injury was caused by one event it is known as a specific injury. In this case the date of the injury is the date of the specific incident. When an injury is caused by repeated exposures it is referred to as a cumulative injury and the date the worker knew or should have known about the injury was caused by work.
The Impairment Rating that is intended to show a percentage of the work-related injury or illness that impacts the body of an injured employee as a whole. This percentage is meant to measure how far away from a persons normal health status and functionality.
Maximum Benefit Amount
The Maximum Benefit Amount is the amount of weekly benefits an employee is allowed within the workers compensation system. The amount cannot be more than the state average weekly wage (SAWW).
Medical Provider Network (MPN):
The Medical Provider Network is an entity or a group of health care providers that are organized by an insurer or a self-insured employer. They are set up to administer managed care for injured employees within the workers compensation system..
Minimum Benefit Amount
The Minimum Benefit Amount is the lowest amount of benefits an employee can get from the workers compensation system. In most states this amount is 15 percent of the state average weekly wage.
Multiple Employment occurs when an injured employee has more than one employer at the time of the injury.
The Non-Claim Employer is the employer an injured worker worked for at thetime of an injury that cause the injured employee to enter the workers compensation system, but this employer is not the claim employer. This is because the injury occurred at the additional employer the injured employee works for. This employer is labeled the claim employer.
Non-Pecuniary Wages are wages that are not paid in cash. These wages may include health insurance premiums, housing allowance, travel reimbursement, or clothing.
Pecuniary Wages are wages that are paid in money, such as salary, commissions, and bonuses. Pecuniary wages include the market value of room and board, laundry, fuel, and any other benefit that can be estimated in money.
Permanent Alternate Position
A permanent Alternate Position is an additional job within the same company that may be offered to an injured worker when the treating physician reports that the injured worker will never be able to return to the same position previously held at the time of the injury or illness. Some people within the industry may refer to this as Alternative Work.
Permanent Disability (PD) Benefits
Permanent Disability Benefits are moneys paid when an injury or illness result in a permanent impairment that prevents the ability of an injured worker to compete in the open market place. The extent of the disability determines the amount an injured employee receives. Additional factors that determine the amount of benefit an injured employee receives include the date of the injury, the age when injured, and the occupation of the injured employee. Permanent Disability benefits are paid every two weeks until the benefit is completely paid or when the employee settles the case and receives a lump sum.
Primary Treating Physician (PTP)
The Primary Treating Physician is the doctor who is primarily responsible for managing the overall care of an injured worker. This is the physician who writes medical reports that impact the worker’s benefits.
Reasonable and Necessary Treatment
Reasonable and Necessary Treatment is the type of medical treatment an injured worker receives when they enter the workers compensation system after an injury or illness caused by their job. The treatment is in line with the standard of care for a specific condition. This standard of care is determined by the governing body within each individual state with recommendation from experienced medical staff as well as insurance professionals.
State Average Weekly Wage
The State Average Weekly Wage is different for each state. In most states it is equal to 88% of the average weekly wage within the state. It is best to check with the state governing body in the state the workers compensation claim is filed to make sure an injured worker is receiving the proper benefits.
Temporary Disability (TD)
Temproary disability is a benefit paid to an injured workers that is paid when the primary treating physician verifies that an injured employee is not able to work because of a work related injury or illness. These benefits are not paid for the first three days an employee misses work. The amount the injured employee is paid is equal to two thirds of the employees wages. The benefits stop when the injured employee returns to work or the treating physician releases the employee for work.
Vocational Rehabilitation (VR)
Vocational Rehabilitation is administered when the Primary Treating Physician for an injured worker determines that the injury is severe enough to limit work now, but has the possibility to get back to normal with treatment. When this is recommended, the employer and injured worker jointly select a rehabilitation counselor who will determine whether vocational rehabilitation is feasible, and develop a suitable rehabilitation plan.
Work Restrictions are administered by a primary treating physician with clear and precise limits on the job tasks for an injured worker within the workers system. The limitations are designed to prevent further injury and to get the injured worker back to normal health as fast as possible.