Navigating the workers compensation system is a difficult task. It is difficult for the injured employee, but it is also difficult for the employer, as well as the health care provider. Everyone involved in the situation should have the injured employee at the forefront of their thoughts while navigating this system. Because of the complicated nature of the workers compensation there has developed a jargon used only within the system. If you are not familiar with this process this jargon will more than likely confuse you no matter if you are the injured employee or the employer trying to get your employee the care they deserve. Here are some terms to familiarize yourself with in order to more effectively navigate the workers compensation system in your state.
Aggravation claim: An aggravation claim is for additional benefits because taht are the result of a worsening of the medical condition by an injured employee after the claim has been closed.
Attending physician: The attending physician is a health care provider who is primarily responsible for the treatment of an injured worker. In some states this person may be called the primary treating physician or treating physician.
Average weekly wage: Average weekly wage is also frequently abbreviated to AWW. It is an amount of the average weekly wage of workers in covered employment. This may be used to calculate benefit rates for temporary disability, permanent partial disability, permanent total disability, and death.
Date of Injury: This is the date when the injured employee got hurt or became ill. If the injury was caused by one traumatic event, it is easily distinguished, but for repeated exposure injuries the date is not actually known. In this case the date is the first date the injured worker knew or should have known the injury was caused by work.
Exclusive remedy: When the workers compensation system in each state were formed, during the first half of the 20th century, the systems were frequently referred to as the ‘exclusive remedy’. The basic concept was that an employee who is injured at work is entitled to medical costs and some lost wages, but may not sue the employer for damages. The one exception is if the injury occurred because of something out of the workers scope or the employer did not take reasonable steps to prevent the injury.
EPLI: EPLI Stands for Employment Practices Liability Insurance. This is an insurance policy to protect a business when it is sued by an employee, a former employee, or a potential employee for hiring practices. In today’s litigious society, anyone can sue another person or business for any reason. The accusations do not have to be founded and your business does not have to be found to have done anything wrong for it to cost an enormous amount of money to the business. An EPLI Policy can protect your business from this risk.
Experience Mod: The Experience Modification Rating is frequently referred to as the Mod or the Experience Mod. The rating compares the businesses loss data to other employers within the same class code of business. The rating is expressed as a credit or debit on your policy. This is the number one factor insurance carriers use to determine what to charge a business for workers compensation insurance premium.
Federal employer identification number: The Federal Employer Identification Number is frequently abbreviated to FEIN. This is essentially the social security number for a business. It is assigned to a business by the Internal Revenue Service.
HIPAA (Health Insurance Portability and Accountability Act): HIPAA is a federal law that is set up to ensure the privacy and security of health information. It also deals with a patients’ access to their health-care records.
Independent contractor: An independent contractor is a person who is contracted to do work but is not subject to the direction and control of an employer. Within the workers compensation system, an independent contractor must purchase coverage for themselves in order to receive benefits. The classification of an independent contractor can vary widely from state to state. Many businesses who think they are using contractors are actually using employees according to the state governing bodies interpretation. If this is the case for you business you need to purchase coverage and if you are an independent contractor yourself you may need to cover yourself.
Managed care organization (MCO): A Managed Care Organization contracts with an insurer to provide medical services to injured workers. If you are an injured employee, it will be important to have frequent communication with both your employer and the managed care organization. If you are the employer helping an injured employee, you need to notify them who the managed care organization is and what the injured employee should expect from them.
Modified work: Modified Work is important to getting injured employees back on the job and a part of your organization again. A modification to an injured worker’s job duties should be designed to accommodate the physical limitations resulting from the injury or disease. This can be important to your business because when injured employee winds up on permanently disability your experience modification rating can be extremely negatively impacted.
Worksite modification: Making modifications to an injured employees worksite is something your managers should be prepared for in order to get injured employees back on the job and part of your organizaiton. The quicker you can get them back in to their work routine, the more likely the injured employee will be to return to full time permanent employment.
Resources:
https://www.hr360.com/Resource-Center/Workers-Compensation-Terms.aspx
https://www.dir.ca.gov/DWC/WCGlossary.htm