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Worker's Compensation Basics

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Worker's Compensation

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A form of insurance providing wage replacement and medical benefits to employees injured in the course of employment.

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Claim

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A formal request by an employee to receive worker's compensation benefits due to a workplace injury or illness.

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Premium

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The amount of money that an employer pays for worker's compensation insurance.

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Experience Modification Rate (EMR)

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A factor used by insurance companies to adjust premiums based on the claim history of a company.

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Temporary Total Disability (TTD)

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Benefits paid when an employee cannot work at all, but only for a limited period.

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Permanent Total Disability (PTD)

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Benefits paid when an employee is permanently unable to perform any kind of work.

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Temporary Partial Disability (TPD)

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Benefits given when a worker can perform some, but not all, of their job duties for a temporary period.

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Permanent Partial Disability (PPD)

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Compensation for workers who have suffered a permanent injury that partially impairs their ability to work.

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Medical Treatment

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Health care services provided to an employee to treat a work-related illness or injury covered by worker's compensation.

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Rehabilitation Services

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Therapies and treatments provided to help an injured worker recover and return to work.

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Death Benefits

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Payments made to the dependents of a worker who dies as a result of a job-related injury or illness.

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Independent Medical Examination (IME)

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An evaluation conducted by a medical professional to determine the extent of a worker's injury or illness.

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Waiting Period

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The time an employee must wait after an injury before worker’s compensation benefits become payable.

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Vocational Rehabilitation

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Assistance given to injured workers to help them return to work, possibly in a new capacity if they can no longer perform their previous job duties.

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Compensable Injury

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An injury that qualifies for worker’s compensation benefits under the law.

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First Report of Injury (FROI)

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A document submitted by an employer to start the worker's compensation claim process after an employee reports an injury.

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Exclusive Remedy

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The legal principle that worker’s compensation benefits are the sole compensation available to injured workers from their employer.

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Managed Care

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A health care system where treatment is overseen by a managing company, often used in worker's compensation to control costs and ensure effective treatment.

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Disability Rating

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A percentage that represents the extent of an injured worker's disability and is used to determine the amount of benefits they receive.

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Notice of Injury

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An official notification that an employee must give to an employer about a work-related injury or illness, usually within a specified time period.

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Statute of Limitations

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The time limit within which a worker can file a worker’s compensation claim after suffering an injury or illness.

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Benefit Review Conference (BRC)

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A meeting between an injured worker, employer, and insurance company, often mediated by a state worker's compensation official, to discuss and resolve a claim dispute.

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Utilization Review

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The process of reviewing the medical necessity and efficiency of health care services provided to an injured worker.

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Light Duty

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Work that is less physically or mentally demanding that an injured employee may do while recovering from an injury.

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Maximum Medical Improvement (MMI)

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The point at which an injured worker's condition is not expected to improve further with medical treatment.

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Occupational Disease

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A disease or illness resulting from the conditions or environment of a particular job.

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Third Party Claim

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A legal action by an injured worker against someone other than their employer (a third party) whose negligence contributed to their work-related injury.

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Average Weekly Wage (AWW)

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Calculation used to determine the wage replacement benefits an injured worker will receive, based on their average earnings.

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Lump-Sum Settlement

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An agreement in which an injured worker receives a one-time payment for workers' compensation benefits instead of ongoing payments.

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Loss of Use/Organ

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Compensation provided when a worker has permanently lost the use of a body part or organ due to a work-related injury.

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