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Worker's Compensation Basics
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Claim
A formal request by an employee to receive worker's compensation benefits due to a workplace injury or illness.
Exclusive Remedy
The legal principle that worker’s compensation benefits are the sole compensation available to injured workers from their employer.
Occupational Disease
A disease or illness resulting from the conditions or environment of a particular job.
Lump-Sum Settlement
An agreement in which an injured worker receives a one-time payment for workers' compensation benefits instead of ongoing payments.
Compensable Injury
An injury that qualifies for worker’s compensation benefits under the law.
Notice of Injury
An official notification that an employee must give to an employer about a work-related injury or illness, usually within a specified time period.
Loss of Use/Organ
Compensation provided when a worker has permanently lost the use of a body part or organ due to a work-related injury.
Worker's Compensation
A form of insurance providing wage replacement and medical benefits to employees injured in the course of employment.
Temporary Partial Disability (TPD)
Benefits given when a worker can perform some, but not all, of their job duties for a temporary period.
Permanent Total Disability (PTD)
Benefits paid when an employee is permanently unable to perform any kind of work.
Utilization Review
The process of reviewing the medical necessity and efficiency of health care services provided to an injured worker.
Death Benefits
Payments made to the dependents of a worker who dies as a result of a job-related injury or illness.
First Report of Injury (FROI)
A document submitted by an employer to start the worker's compensation claim process after an employee reports an injury.
Managed Care
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.
Premium
The amount of money that an employer pays for worker's compensation insurance.
Rehabilitation Services
Therapies and treatments provided to help an injured worker recover and return to work.
Temporary Total Disability (TTD)
Benefits paid when an employee cannot work at all, but only for a limited period.
Waiting Period
The time an employee must wait after an injury before worker’s compensation benefits become payable.
Medical Treatment
Health care services provided to an employee to treat a work-related illness or injury covered by worker's compensation.
Disability Rating
A percentage that represents the extent of an injured worker's disability and is used to determine the amount of benefits they receive.
Light Duty
Work that is less physically or mentally demanding that an injured employee may do while recovering from an injury.
Permanent Partial Disability (PPD)
Compensation for workers who have suffered a permanent injury that partially impairs their ability to work.
Experience Modification Rate (EMR)
A factor used by insurance companies to adjust premiums based on the claim history of a company.
Vocational Rehabilitation
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.
Benefit Review Conference (BRC)
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.
Maximum Medical Improvement (MMI)
The point at which an injured worker's condition is not expected to improve further with medical treatment.
Third Party Claim
A legal action by an injured worker against someone other than their employer (a third party) whose negligence contributed to their work-related injury.
Average Weekly Wage (AWW)
Calculation used to determine the wage replacement benefits an injured worker will receive, based on their average earnings.
Independent Medical Examination (IME)
An evaluation conducted by a medical professional to determine the extent of a worker's injury or illness.
Statute of Limitations
The time limit within which a worker can file a worker’s compensation claim after suffering an injury or illness.
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