Workers’ Compensation Glossary

Accepted claim: A claim in which the insurance company accepts that your injury or illness will be covered by workers’ compensation. 

Agreed medical evaluator (AME): This is the physician that is agreed to by your attorney and insurance company. The AME will be the one to conduct your medical evaluations. 

Alternative work: If your doctor says you will not be able to return to your job because of your injury, your employer is encouraged to offer you alternative work instead of your regular work duties. There are requirements to this alternative work, such as meeting your work restrictions, that vary by state. 

American Medical Association (AMA): National physician’s group. The AMA has published the permanent impairment guidelines. 

Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. 

AOE/COE (Arising out of and occurring in the course of employment): Injury caused by and happened while on the job. 

Appeals board: A group of seven commissioners appointed by the governor to review and reconsider decisions of workers’ compensation administrative law judges. 

Applicants’ attorney: A lawyer that can represent the injured worker in a workers’ compensation case. 

Apportionment: A way of figuring out how much of your permanent disability is due to your work injury and how much is due to other disabilities.

Benefit notice: A required letter or form sent to you by the insurance company to inform you of benefits you may be entitled to receive.

Carve-out: Carve-out programs allow employers and unions to create their own alternatives for workers’ compensation benefit delivery and dispute resolution under a collective bargaining agreement.

Claim form: The form used to report a work injury or illness to your employer. The form is filed out and turned in at your place of business.

Claims administrator: The term for insurance companies and others that handle your workers’ compensation claim. 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. 

Commutation: An order by a workers’ compensation judge for a lump sum payment of part or all of your permanent disability award.

Cumulative injury: An injury that was caused by repeated events at work.

Date of injury: If your injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated events, the date of injury is the date you knew, or should have known, the injury was caused by work.

Death benefits: Benefits paid to surviving dependents when a work injury results in death.
Defendant: The party, usually an employer or its insurance company, opposing you in a dispute over benefits.

Delay letter: A letter sent to you by the insurance company explaining why payments are delayed. 

Denied claim: A claim in which the insurance company does not believe that your injury or illness was work related and therefore denies your claim. Disability: A physical or mental impairment that limits everyday activities. 

Disability management: A process to prevent disability from occurring or to intervene early and encourage and support continued employment. Disability rating: See permanent disability rating.

Discrimination claim: A petition filed if your employer has fired or discriminated against you for filing a workers’ compensation claim.

Dispute: A disagreement about your right to payments, services or other benefits.

Employee: A person whose work activities are under the control of an individual or entity.

Employer: The person or entity whose has control over your 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. Selecting, designing and modifying equipment, tools, and the work environment are all considered.

Essential functions: Duties considered crucial to the job you want or have.

Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or those who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained

Filing: Sending or delivering a document to an employer or a government agency as part of a legal process. The date of filing is the date the document is received.

Final order: A decision or award made by a workers’ compensation judge.

Findings & award: A written decision by a judge about a case. This decision is final unless an appeal is filed. Fraud: Any knowingly false statement made for the purpose of obtaining workers’ compensation benefits. 

Future medical: On-going right to medical treatment for a work-related injury.

Hearings: Legal proceedings in which a judge discusses the issues in a case or receives information in order to make a decision about a dispute.

In pro per: One who is not represented by an attorney.

Independent contractor: Some employers classify employees as an independent contractors to avoid workers’ compensation. If your employer controls the manner of your work, has the right to terminate you, pays you an hourly wage or salary, requires you to work a specific schedule and makes deductions for Social Security or unemployment, then you are likely NOT an independent contractor. 

Impairment rating: A percentage estimate of how much normal use of your injured body parts that you have lost. Impairment ratings are based on guidelines published by the AMA.

Lien: A right or claim for payment against a workers’ compensation case.

Maximal medical improvement (MMI): Once it is unlikely that your condition will change or improve with or without further medical treatment, an MMI is determined. Once you reach MMI, a doctor can assess a permanent disability rating.

Medical-legal report: A report written by a doctor that describes your medical condition. These reports are written to help clarify disputed medical issues.

Medical treatment: Treatment required to cure or relieve the effects of an injury or illness. 

Modified work: Your old job is changed to allow you to continue doing it with your current injury.

Party: Generally includes anyone who has an interest in your claim (i.e. the insurance company, your employer, attorney, etc.) 

Permanent and stationary (P&S): Your medical condition has reached maximum medical improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted from your work injury.

Permanent disability: Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached.

Permanent disability rating: A percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity. It determines the number of weeks you are entitled to permanent disability benefits.

Permanent disability benefits: Payments you receive when your work injury permanently limits the kinds of work you can do or your ability to earn a living.

Permanent disability advance: A voluntary lump sum payment of permanent disability you are entitled to in the future. 

Permanent disability payments: A mandatory bi-weekly payment based on the portion of permanent disability received before and/or after an award is issued.

Permanent partial disability benefits: Payments you receive when your work injury partially limits the kinds of work you can do or your ability to earn a living.

Permanent total disability benefits: Payments you receive when you are considered permanently unable to earn a living.

Penalty: An amount of money you receive because something wasn’t done correctly in your claim. 

Petition for reconsideration: A legal process to appeal a decision issued by a judge. 

Pre-designated physician: A physician that can treat your work injury if you advised your employer in writing, before the injury occurred. You can pre-designate your personal doctor or a doctor of osteopathy (D.O.).

Reconsideration of a summary rating: A process used when you don’t have an attorney and you think mistakes were made in your permanent disability rating.

Regular work: Your old job, paying the same wages and benefits as paid at the time of an injury and located within a reasonable commuting distance of where you lived at the time of your injury.

Settlement: An agreement between you and the insurance company regarding your workers’ compensation payments and future medical care. Settlements must be reviewed by a workers’ compensation judge to make sure they are adequate.

Serious and willful misconduct: A petition filed if your injury is caused by the serious and willful misconduct of your employer.

Specific injury: An injury caused by one event at work.

Stipulated rating: Formal agreement on your permanent disability rating. Must be approved by a workers’ compensation judge.

Stipulation with award: A settlement of a case where the parties agree on the terms of an award. This is the document the judge signs to make the award final. 

Stipulations with request for award: A settlement in which the parties agree on the terms of an award. Payment takes place over time. 

Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker’s permanent disability. Subjective factors are generally not given as much weight as objective factors. 

Subpoena: A document that requires a witness to appear at a hearing.

Summary rating: The percentage of permanent disability.

Temporary disability: Payments received if you lose wages because your injury prevents you from doing your usual job while recovering.

Temporary partial disability benefits: Payments you receive if you can do some work while recovering, but you will earn less in wages. 

Temporary total disability benefits: Payments you get if you cannot work at all while recovering physician.

Utilization review: The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.

Vocational & return to work counselor: If you have a permanent disability, this is the person that will help you develop a strategy for returning to work. This person will evaluate you and provide necessary counseling. 

Vocational rehabilitation: If you are permanently unable to do your usual job, and your employer does not offer other work, you may qualify for this benefit. It may include job placement counseling, retraining and a vocational rehabilitation maintenance allowance.

Work restrictions: A doctor’s description of the work you can and cannot do.

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