Workers' Compensation ch. 15 key terms

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28 terms · Fordney

accident

an unexpected happening, causing injury traceable to a definite time and place.

adjudication

A final determination of the issues involving settlement of an insurance claim; also know as a claim settlement.

by report

A report must be submitted with the claim when the notation "BR" follows the procedure code dexcription. This tem is sometimes seen in workers' compensation fee schdules

claims examiner

In industrial cases, a representative of the insurer who authorizes treatment and investigates, evaluates, adn negotiates the patient;s insurance claim and acts for the company in the settlementof claims; also know as claims adjuster, claim representative, and claims administrator

deposition

The process of taking sworn testimony from a witness out of court. this is usually done by an attorney

ergonomic

Science and technology that seeks to fit the anatomic and physical needs of the worker to the workplance

extraterritorial

sate laws effective outside the state by either specific provision or court decision. In workers' compensation cases, benefits under the state law that apply to a compensable injury of an employee hired in one state but injured outside that state

Federal Employees' Compensation Act

FECA, An act instituted in 1908 providing benefits for on-the-job injuries to all federal employees

fee schedule

A list of charges or established allowances for specific medical services and procedures

injury

In a workers' compensation policy, this term signifies any trauma or damage to a body part or disease sustained, arising out o, and in the course of employment, including injury to artificial members and medical braces of all types.

insurance adjuster

An individual at the workers' compensation insurance carrier overseeing an industrial case, authorizing diagnostic testing and medical treatment, and communicating with provider of medical care

lien

A claim on the property of another as security for a debt. In litigation cases, it is a legal promise to satisfy a debt owed by the patient to the physician out of any proceeds received on the case.

medical service order

An authorization given to the physician, either written or verbal, to treat the injured or ill employee

nondisability claim

ND, A claim for an on-the-job injury that requires medical care but does not result in loss of working time or income

Occupational Safety and Health Administration

OSHA, A federal agency that regulates and investigates safety and health standards in work locations

permanent disability

an illness or injury (impairment of he normal use of a body part) expected to continue for the lifetime of the injured worker that prevents the person from performing the functions of his or her regular occupation, therefore impairing his or her earning capacity

petition

A formal written request commonly used to indicate an appeal'; also means any request for relief other than an application.

second-injury fund

see Subsequent injury fund

sequelae

Diseased conditions after, and usually resulting from, a previous disease

sub rosa film

Videotapes made without the knowledge of the subject; used to investigate suspicious claims in workers' compensation cases

subsequent injury fund

SIF, A special fund that assumes all or part of the liability for benefits provided to a work because of the combined effect of a work-related impairment and a preexisting condition; also known as secondary-injury fund.

temporary disability

TD, The recovery period after a work-related injury during which the employee is unable to work and the condition has not stabilized; a schedule of benefits payable for the temporary disability.

third-payment liability

exists if an entity is liable to pay the medical cost for injury, disease, or disability of a person hurt during the performance of is or her occupation and the injury is caused by an entity not connected with the employer.

third-party subrogation

The legal process by which an insurance company seeks from a third party, who has caused a loss, recovery of the amount paid to the policyholder.

waiting period

WP, For disability insurance, the initial period of time when a disabled individual is not eligible to receive benefits even though unable to work; for workers' compensation, the days that must elapse before workers' compensation weekly benefits become payable.

work hardening

An individualized program of therapy using simulated or real job duties to build up strength and improve the worker's endurance to be able to work up to 8 hours per day. Sometime work site modifications are instituted to get the employee back to gainful employment

Workers' Compensation Appeals Board

WCAB, The board that handles workers' compensation liens and appeals.

workers' compensation insurance

WC, a contract that insures a person against on-the-job injury or illness. The employer pays the premium for his or her employees.

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