50 terms

mod 110 wk 2

an unexpected happening, causing injury traceable to a definite time and place
the final determination of the issue involving settelment of an insurance claim
by report (BR)
a report must be submitted with the claim when notation "BR" follows the procedure code description
claim examiner
in industrial cases, a representative of the insurer who autherizes treatment and investigates, evaluates, and negotiates the patient's insurance claim and acts for the company in the settlement of claim
compromise and release
an agreement arrived at, wether in or out of court, for setteling a workers' compensation case after the patienthas been declared permanent and stationary(P&S)
the process of taking sworn testimony from a witness out of court. This is usually done by an attorney
science and technology that seek to fit the anatomic and physical needs of the worker to the workplace
state laws effictive outside the state be either specific provision or court decision.
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 allowence for specific medical services and procedures.
In a workers' compensation policy, this term signifies any truma or damage to a body part or disease sustained, arising out of, and in the course of employment, including injury to artifical members and medical braces of all types
insurance adjuster
An individual at the workers' comp insurance carrier overseeing an industrial case, autherizing diagnostic testing and medical treatment, and communication with the provider of medical care.
A claim on the property of another as security for a debt.
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
premanent disability (PD)
in illness or injury expected to continue for the lifetime of the injured worker that prevents the person from prefoming the functions of his or her reguar occupation
formal written request commonly used to indicate; also means any request for relief other than an application
sub rosa films
videotapes made without the knowledge of the patient; used to prove insurance fraud against an injured worker
temporary disability
The recovery period after a work-related injury during which the employee is unable to work and condition has not stabilize
third party liability
Tird-party liability exists if an entity is liable to pay the medical cost forinjury, or disability of a person hurt during the performance of his or her occupation and the injury by an entity not connected with the employer
third party subrogation
The legal process by whick an insurance comopany 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 the time when as disable individual is not eligible to recieve benifits
work hardening
An individual program of therapy using simulated or real job duties to build up strength
workers' compensation appeal board (WCAB)
The board that handels workers' comp 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.
conversion factor
The dollars and cents amount that is established for one unit as applied to a procedure or service renderd
endotracheal anesthesia
is accomplished by insertion of a tube into the nose or mouth, and passing the tube into the trachea for ventilation
general anesthesia
qualifying circumstance
code is reported in addition to the primary anesthesia procedure colde
physical status modifier
surgical puncture
surgical repair
new opening
bursting forth
heria, tumor, swelling
bladder, sac
instument of recording
motion, movement