WORKERS COMPENSATION FOR INJURED WORKERS
The information contained in this fact sheet is general in nature and is not intended as a substitute for legal advice. Changes in the law or the specific facts of your case may result in legal interpretations different than those presented here.
DWC fact sheet B Rev. 7/05
ACCEPTED CLAIM
A claim in which the insurance company agrees your injury or illness is covered by workers’ compensation. Even if your claim is accepted there may be delays or other problems. Also called admitted claim.
ACOEM
American College of Occupational and Environmental Medicine. Until the state Division of Workers’ Compensation (DWC) adopts medical treatment guidelines, the guidelines published by ACOEM, called “Occupational Medicine Practice Guidelines,” are the guidelines used in most cases to decide the type and amount of treatment you’ll receive for a work injury or illness.
AGREED MEDICAL EVALUATOR (AME)
If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. If you don’t have an attorney, you will use a qualified medical evaluator (QME). See QME.
ALTERNATIVE WORK
A new job with your former employer. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured, and be within a reasonable commuting distance of where you lived at the time of injury.
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).
WORKERS’ COMPENSATION JUDGE
See workers’ compensation administrative law judge.
WORKERS’ COMPENSATION ADMINISTRATIVE LAW JUDGE
A DWC employee who makes decisions about workers’ compensation disputes and approves settlements. Judges hold hearings at local Workers’ Compensation Appeals Board (WCAB) offices, and their decisions may be reviewed and reconsidered by the Reconsideration Unit of the WCAB. Also called workers’ compensation judge.
WORK RESTRICTIONS
A doctor’s description of the work you can and cannot do. Work restrictions help protect you from further injury.
WORKERS’ COMPENSATION INSURANCE RATING BUREAU (WCIRB)
An agent of the state Department of Insurance and funded by the insurance industry, this private entity provides statistical and rating information for workers’ compensation insurance and employer’s liability insurance, and collects and tabulates information to develop pure premium rates.
WAGE LOSS (TEMPORARY PARTIAL DISABILITY)
See temporary partial disability benefits.
VOUCHER
See supplemental job displacement benefit and nontransferable voucher.
VOCATIONAL REHABILITATION MAINTENANCE ALLOWANCE (VRMA)
Payments to help you with living expenses while participating in vocational rehabilitation. See vocational rehabilitation.
VOCATIONAL REHABILITATION (VR)
A workers’ compensation benefit. If you were injured before 2004 and are permanently unable to do your usual job, and your employer does not offer other work, you qualify for this benefit. It includes job placement counseling to help you find another job. It may also include retraining and a vocational rehabilitation maintenance allowance.
VOCATIONAL & RETURN TO WORK COUNSELOR (VRTWC)
If you have a permanent disability, this is the person or entity that helps you develop a return to work strategy. They evaluate you, provide counseling and help you get ready to work. A VRTWC must have at least an undergraduate degree in any field and three or more years of full time experience.
UTILIZATION REVIEW (UR)
The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.
UNINSURED EMPLOYERS FUND (UEF)
A fund, run by the DWC, through which your benefits can be paid if your employer is illegally uninsured for workers’ compensation.
TREATING PHYSICIAN
See primary treating physician.
TREATING DOCTOR
See primary treating physician.
TRANSPORTATION EXPENSES
A benefit to cover your out-of-pocket expenses for mileage, parking and toll fees related to a claim. Usually a reimbursement.
TEMPORARY TOTAL DISABILITY (TTD) BENEFITS
Payments you get if you cannot work at all while recovering.
TEMPORARY PARTIAL DISABILITY (TPD) BENEFITS
Payments you get if you can do some work while recovering, but you earn less than before the injury.
TEMPORARY DISABILITY (TD OR TTD)
Payments you get if you lose wages because your injury prevents you from doing your usual job while recovering.
