Glossary
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A
Adjudication
The administrative procedure used to process a claim for service according to the covered benefit.
Alternative work
A new job with former employer. If doctor says employee will not be able to return to job at the time of injury, the employer is encouraged to offer alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits.
American Medical Association (AMA)
A national physician's group. The AMA publishes a set of guidelines called "Guides to the Evaluation of Permanent Impairment." If your permanent disability is rated under the 2005 rating schedule, the doctor is required to determine your level of impairment using the AMA's guides.
Americans with Disabilities Act (ADA)
A federal law that prohibits discrimination against people with disabilities. If you believe you've been discriminated against at work because you're disabled and want information on your rights under the ADA, contact a U.S. Equal Employment Opportunity Commission office. For the EEOC office in your area, call 1-800-669-4000 or 1-800-669-6820 (TTY).
AOE/COE
Arising out of and occurring in the course of employment. Refers to the fact that an Injury must be caused by and happen on the job.
C
Claim form
The form used to report a work injury or illness to employers.
Claims adjuster
See claims administrator.
Claims administrator
The term for the entity that handles workers' compensation claims. Most claims administrators work for insurance companies or third party administrators handling claims for employers. Some claims administrators work directly for large employers that handle their own claims. Also called claims examiner or claims adjuster.
CMS
Centers for Medicare & Medicaid Services
Cumulative Injury
An injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over or losing your hearing because of constant loud noise.
D
Date of injury
Date injury occurred. If the injury or illness was caused by repeated exposures (a cumulative injury), the date of injury is the date employee knew or should have known the injury was caused by work.
Disability
A physical or mental impairment that limits life activities. A condition that makes engaging in physical, social and work activities difficult.
Disability management
A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment. This is done early in the recovery process in severe injury cases such as spinal injuries
DME
Durable medical Equipment
E
Employee
A person whose work activities are under the control of an individual or entity. The term employee includes undocumented workers and minors.
Employer
The person or entity with control over work activities.
Ergonomics
The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work. That means considering the variability in human capabilities when selecting, designing or modifying equipment, tools, work tasks and the work environment.
F
FCM
Field Case Management
Fraud
Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers' compensation benefits. The penalties for committing fraud are fines up to $150,000 and/or imprisonment for up to five years.
H
HCN
Health Care Network
Health Care Organization (HCO)
An organization certified by the Department of Industrial Relations to provide managed medical care within the workers' compensation system.
I
IME
Independent Medical Exam
IDM
Integrated Disability Management
L
Legacy Claim
Claims that existed prior to the date the HCN was implemented by the employer
M
Managed Care
Medical delivery system that attempts to manage the quality and cost of medical services that individuals receive; PPOs are managed care plans.
MCO
Managed Care Organization
Medical treatment
Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care.
MPN
Medical Provider Network
MSA
Medicare Set-Aside
Modified Work
Employees old job, with some changes that allow injured employee do to it.
N
NCCI
National Council on Compensation Insurance
NT
Nurse Triage
P
PBR
Provider Bill Review
PPO
Preferred Provider Organization
R
RTW
Return to Work
RX
Pharmacy
T
TCM
Telephonic Case Management
U
Utilization review (UR)
The process used by insurance companies to decide whether to authorize and
W
WCRI
Workers’ Compensation Research Institute
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