Definitions Associated with Workers Compensation

  • Apportionment: allows the carrier to take credit at the time of settlement for permanent disability when an injured worker had a prior disability or when a pre-existing injury or condition impairs their recovery.
  • Compensability: determining if the injured worker is owed and entitled to benefits based on the details of the claim, state laws and statutes. A determining factor is did the injury Arise Out of Employment /Course of Employment (AOE/COE).
  • Full Duty: the injured worker is released to work regular duties without any work restrictions.
  • Job Description: a detailed description of the employee’s job duties performed up to and including the time of injury.
  • Maximum Medical Improvement (MMI): the injured worker has recovered to the fullest extent possible. The Doctor determines the employee has reached a permanent and stationary status (P&S) to the point where no additional medical or emotional change can be expected.
  • Medical Plan Network (MPN): a group of recognized health care providers and specialists set up to treat injured workers. The use of such assigned medical treatment facilities assists employers and carriers with maintaining control of medical care and the associated costs.
  • Modified Duty: a doctor determines the need for work restrictions to be implemented, in association with the normal job duties and assignments performed by the injured worker.
  • Peer Review: additional information is needed before UR can reach a final decision. A physician within the UR contacts the requesting physician in order to obtain additional information needed to reach a determination. The newly acquired information is sent to UR and a final determination is made based on the necessity of the requested medical treatment.
  • Permanent Disability (PD): a permanent impairment is found to exist once the doctor has deemed the injured worker to be MMI.
  • Subrogation: the workers compensation carrier seeks reimbursement for costs associated with the claim when a third party is responsible for having caused the injury.
  • Temporary Total Disability (TTD): the injured worker is not capable of working regular duties or modified duties for a temporary period of time. This term is also used when employers are not able to accommodate the modified duty restrictions.
  • Utilization Review (UR): the carrier submits referrals and requests for authorization received from the treating physician to a panel of experts for authorization. Final determinations and authorizations are granted based on the necessity of the requested medical treatment.
  • Wage Loss Continuation: wages paid to the injured worker by the carrier when the employee has sustained a loss of income (whole or in part) due to the work related injury.