The administrative procedure used to process a claim for service according to the covered benefit.
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).
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.
The form used to report a work injury or illness to employers.
See 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.
Centers for Medicare & Medicaid Services
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.
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.
A physical or mental impairment that limits life activities. A condition that makes engaging in physical, social and work activities difficult.
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
Durable medical Equipment
A person whose work activities are under the control of an individual or entity. The term employee includes undocumented workers and minors.
The person or entity with control over work activities.
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.
Field Case Management
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.
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.
Independent Medical Exam
Integrated Disability Management
Claims that existed prior to the date the HCN was implemented by the employer
Medical delivery system that attempts to manage the quality and cost of medical services that individuals receive; PPOs are managed care plans.
Managed Care Organization
Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care.
Medical Provider Network
Employees old job, with some changes that allow injured employee do to it.
National Council on Compensation Insurance
Provider Bill Review
Preferred Provider Organization
Return to Work
Telephonic Case Management
Utilization review (UR)
The process used by insurance companies to decide whether to authorize and
Workers’ Compensation Research Institute