Worker's Compensation Terminology & Acronyms
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Questions and Answers

What does 'arising out of employment' mean in the context of worker's compensation?

  • The accident occurred while the employee was engaged in a task for their employer and was required to be at the location at the time of the accident. (correct)
  • The accident happened because the employee did something the employer had warned them not to do.
  • The accident occurred while the employee was on their way home from work.
  • The accident happened while the employee was not at work.

What does Average Weekly Wage (AWW) represent?

  • The average amount an employee earns per week after injury.
  • An employee's pre-injury earning capacity, based on earnings in the specific period before a work-related incident. (correct)
  • The amount of money an employee would earn if they worked overtime every week.
  • An employee's earning capacity after the work-related injury or illness.

Which of the following best describes a 'cumulative injury' in worker's compensation?

  • An injury that occurred when the employee was not actively working, but on work property.
  • An injury that occurs suddenly from a single event.
  • An injury that results from repeated exposures over time. (correct)
  • An injury that is not work-related.

What happens when an insurance carrier 'denies' a worker's compensation claim?

<p>The insurance carrier refuses to cover the worker's compensation claim. (A)</p> Signup and view all the answers

In the context of worker's compensation, what is 'Dispute Resolution'?

<p>A method to settle disagreements about various aspects of a worker's compensation claim. (D)</p> Signup and view all the answers

What is the purpose of a 'Fee Schedule' within Worker's Compensation?

<p>To specify the maximum allowable rate a medical provider can charge for a specific service. (B)</p> Signup and view all the answers

In worker's compensation, what is an 'Impairment Rating'?

<p>An estimate of the loss of normal use of an injured body part, based on guidelines published by the AMA. (B)</p> Signup and view all the answers

What is a Letter of Protection (LOP) primarily designed to ensure?

<p>Guaranteed payment for medical expenses of an injury victim (B)</p> Signup and view all the answers

Which of these roles is often referred to as the attorney's 'right-hand' person within a law firm?

<p>Legal Assistant (C)</p> Signup and view all the answers

What does a Medicare set-aside agreement (MSA) primarily manage in workers' compensation cases?

<p>Funds for projected medical expenses for Medicare beneficiaries (D)</p> Signup and view all the answers

What is the main purpose of mediation in legal disputes?

<p>Assisting parties to negotiate their differences with a neutral party (A)</p> Signup and view all the answers

What is the primary difference between a 'statute' and a 'regulation'?

<p>Statutes are laws passed by legislative bodies, while regulations clarify these laws. (A)</p> Signup and view all the answers

In a scenario where an employee is injured in an auto accident while driving a company car, what would be considered the 'third-party claim'?

<p>A claim against the at-fault driver or their insurance provider (A)</p> Signup and view all the answers

What is the 'statute of limitations' (SOL) primarily related to?

<p>The time limit for initiating a law suit after an injury (D)</p> Signup and view all the answers

What is the main function of an Office Manager?

<p>To handle the administrative operations in a company. (B)</p> Signup and view all the answers

What is a primary function of LexisNexis in the legal field?

<p>It serves as a platform for legal research and information. (A)</p> Signup and view all the answers

Who are typically considered parties to a claim in Virginia Workers' Compensation?

<p>Injured worker, employer, insurance carrier, claim administrator (A)</p> Signup and view all the answers

What are Permanent Partial Disability Benefits (PPD) intended to compensate for?

<p>Permanent loss of use of specific body parts (D)</p> Signup and view all the answers

What conditions must be met for an injured worker to receive Permanent and Total Disability Benefits (PTD)?

<p>Loss of both hands, arms, feet, legs, or severe brain injury (B)</p> Signup and view all the answers

What penalty can an injured worker request if compensation is not paid within two weeks after it becomes due?

<p>A 20% penalty against the insurance carrier for untimeliness (D)</p> Signup and view all the answers

Which of the following is NOT included under Permanent Partial Disability Benefits?

<p>Back injuries (C)</p> Signup and view all the answers

What actions can a health care provider take if there is a dispute about reimbursement for medical charges?

<p>File a claim or request mediation. (B)</p> Signup and view all the answers

Who is responsible for medical costs if an injured worker seeks treatment outside of their authorized physician?

<p>The injured worker may be responsible. (C)</p> Signup and view all the answers

What does the 'Notification of Injury' letter inform the parties about?

<p>Their rights and responsibilities. (B)</p> Signup and view all the answers

What must an employer provide to an injured worker after an accident?

<p>A panel of at least three physicians. (C)</p> Signup and view all the answers

What is meant by 'Occupational Disease' under the Virginia Workers' Compensation Act?

<p>A disease that arises out of employment but is not widely exposed outside of work. (C)</p> Signup and view all the answers

What happens if an injured worker fails to cooperate with medical treatment?

<p>Their weekly benefits may be suspended. (B)</p> Signup and view all the answers

Which of the following is NOT a necessary element in the notice given to the employer after an accident?

<p>Detailed medical history. (A)</p> Signup and view all the answers

What role do narrative medical records play in the workers' compensation process?

<p>They describe the injured worker's medical condition. (B)</p> Signup and view all the answers

When can an injured worker change their treating physician?

<p>Only with employer/insurance carrier approval or after a Commission hearing. (D)</p> Signup and view all the answers

What is the primary responsibility of the Commission once an injury is reported?

<p>To send the Notification of Injury letter to involved parties. (C)</p> Signup and view all the answers

What does JCN stand for in the context of workers' compensation?

<p>Joint Claim Number (D)</p> Signup and view all the answers

Which statement correctly defines Lifetime Medical Benefits?

<p>They cover medical expenses as long as they are reasonable and necessary. (A)</p> Signup and view all the answers

What are Light Duty Restrictions?

<p>A description from the physician of what work the injured worker can do. (B)</p> Signup and view all the answers

When does an injured worker reach Maximal Medical Improvement (MMI)?

<p>When their injury is well stabilized and unlikely to substantially change. (D)</p> Signup and view all the answers

What does the Medical Fee Schedule (MFS) in Virginia Workers' Compensation entail?

<p>Outlines maximum fees for healthcare services related to work injuries. (D)</p> Signup and view all the answers

What is the purpose of a Medical Only Award in workers' compensation?

<p>To ensure lifetime medical benefits for necessary treatment only. (C)</p> Signup and view all the answers

Which of the following statements about lien rights in workers' compensation is true?

<p>A lien is a claim for payment against a workers' compensation case. (B)</p> Signup and view all the answers

How long does an injured worker typically have to file a claim for wage replacement following an injury?

<p>Two years from the date of injury. (C)</p> Signup and view all the answers

What characterizes the term 'Mediation' in the context of workers' compensation?

<p>A form of alternative dispute resolution. (B)</p> Signup and view all the answers

What is a requirement for reimbursement of out-of-pocket medical expenses by an injured worker?

<p>The expenses must be included in a claim filed prior to treatment. (A)</p> Signup and view all the answers

Flashcards

Arising out of employment

A situation where the employee was doing their job and the work-related duties caused the injury.

Average Weekly Wage (AWW)

The amount of money an injured worker earned before getting hurt, used to calculate benefits.

Claimant

The person who files a worker's compensation claim, often the injured worker.

Date of Injury (DOI)

The specific date when an injury occurred, either when the accident happened or when the worker became aware of the injury.

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Denied Claim

When an insurance company refuses to pay for a worker's compensation claim.

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Dispute Resolution

A process for resolving disagreements about worker's compensation claims.

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Division of WC

A state agency responsible for managing the worker's compensation system in a state.

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What are Permanent Partial Disability Benefits (PPD)?

Benefits paid for the permanent loss of use of a body part, like an arm or finger.

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What are examples of permanent partial disability benefits?

Separate benefits paid for the permanent loss of use of a body part, like an arm, leg, finger, or eye. It includes vision and hearing loss, and disfigurement.

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What are Permanent and Total Disability Benefits (PTD)?

Benefits paid to injured workers who cannot work due to a disability, such as paralysis or severe brain injury.

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What is a penalty in Virginia Workers' Compensation?

A penalty assessed by the Commission for untimely payments of compensation to injured workers.

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What is a Petition and Order in Virginia workers' compensation?

This is another term for a compromise settlement agreement between the parties involved in a workers' compensation claim.

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Legal Assistant

A person trained in legal matters but not fully qualified as a lawyer. Often assists attorneys in a law firm.

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Letter of Protection (LOP)

A legally binding document guaranteeing payment for medical expenses between an injury victim, their attorney, and their medical provider.

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LexisNexis

A privately published legal research database widely used by attorneys.

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Mediation

A process where parties meet with a neutral person to negotiate disagreements and reach a resolution.

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Medicare Set-Aside Agreement (MSA)

An agreement in workers' compensation cases where funds are set aside to pay for future medical expenses for a Medicare beneficiary.

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Paralegal

A person trained in subsidiary legal matters, often assisting attorneys with legal research and tasks.

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Regulation

A law, rule, or order prescribed by authority to regulate conduct. Often clarify laws passed by legislatures.

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Statute

A written law passed by a legislative body and signed by a governor.

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Statute of Limitations (SOL)

A legal time limit within which a lawsuit must be filed. Applies to cases such as car accidents involving company vehicles.

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Lien

A right or claim for payment against a workers' compensation case.

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Lifetime Medical Benefits

Medical expenses for conditions caused by the accident or occupational disease are payable for as long as needed, provided a claim was filed within the required time period and the expenses are reasonable and necessary.

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Light Duty Restrictions

The treating physician's description of the work an injured worker can and cannot do.

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Maximal Medical Improvement (MMI)

An injury that is well stabilized and unlikely to change substantially, with or without medical treatment.

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Medical Fee Schedules

The Virginia Workers' Compensation Medical Fee Schedules (MFS) outline maximum fees for health care providers, hospitals, and ambulatory surgical centers, rendering health care services to injured workers.

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Medical Only Award

An Award that provides lifetime medical benefits for reasonable, necessary, and authorized medical treatment causally related to the work-related injury; this Award does not provide wage replacement.

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JCN (Jurisdictional Case Number)

A number assigned to a workers' compensation case, formerly known as the VWC File Number.

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Reimbursement

The injured worker is entitled to reimbursement for out-of-pocket medical expenses (prescriptions) and reasonable medical mileage.

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Statute of Limitations

A claim must normally be filed within two years from the date of injury (certain statutes pursuant to Code Section 65.2 may toll the statute of limitations).

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Narrative Medical Records

A written report by a doctor detailing an injured worker's medical condition. It follows specific guidelines for submission.

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Occupational Disease

A disease caused by work and not common in the general public. Imagine a disease specific to a job like black lung from coal mining.

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Notice of Injury

When an employee is injured, they must inform their employer ASAP, including details like the injury, time, and place.

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Panel of Physicians

The employer provides a list of doctors the worker can choose from for treatment.

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Medical Treatment

The employer is responsible for covering medically necessary care for a work injury. This could include visits, tests, and therapies.

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Notification of Injury

A letter sent by the commission notifying everyone involved of their rights and responsibilities after an injury is reported.

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Unauthorized Treatment

If a worker gets treatment outside their assigned doctor, they might be responsible for the cost.

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Medical Provider Dispute

When a dispute arises over medical bills, the provider can file a claim or request mediation to resolve the disagreement.

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Cooperation with Treatment

Workers are required to cooperate with their treatment plan or risk losing their benefits.

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Employer's Responsibility for Panel Physician

The employer is responsible for providing a doctor chosen by the worker from a panel of at least three doctors.

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Study Notes

Terminology & Acronyms

  • This presentation covers terminology and acronyms related to VA (likely Worker's Compensation).
  • Information is categorized into general and specific, including worker's compensation terms, medical terms, and legal terms.

Part 1: Terminology (General)

  • Worker's Compensation (WC) terms: Defines key terms like Arising out of employment, Average Weekly Wage (AWW), Claimant (injured worker), Date of Injury (DOI), Denied Claim, Dispute Resolution, Disputed claim, Division of WC, Fee Schedule, Impairment guidelines, Impairment Rating, etc.
  • Detailed descriptions are provided for each term. For example, AWW is defined as an employee's pre-injury earning capacity.

Part A: WC Industry Terms

  • More detailed descriptions of industry terms for worker's compensation (WC) are provided like insurance carrier definition, Maximum Medical Improvement (MMI), Medical Treatment Guidelines, Modified Job Duty/Mod Work, Nurse Case Manager, Permanent Disability, Return to work (RTW), Self-Insured.

Part B: Medical Industry & Medical Office Terms

  • Medical terms: Includes American Medical Association (AMA) Impairment Ratings, Balance billing, Controlled Substances, Demographics (patient information), EPCS (electronic prescribing), and Face Sheet.
  • Additional medical terms like Future medicals and more are discussed in further slides.

Part C: Legal & Law Firm Terms

  • Legal terms: Defines Administrative Hearing, Attorney, Case Law, Compensable claim, Expert witness, Holiday indemnification, Lawyer, Legal Assistant, Letter of Protection (LOP), LexisNexis, Mediation
  • Pharmacy-related terms: Includes Adjudicate, Average Wholesale Price (AWP), Fee Schedule, First Fill Program, and Letter of Medical Necessity (LOMN).

Part E: Internal (EZ Scripts) Terms

  • Internal terms (EZ Scripts) - Covers Concur, EZ Scripts University, MOTUS, Marketing Collateral, New Patient Shipped (NPS), Referral meeting, Salesforce, SharePoint, Welcome Packet—all pertain to internal business processes and software at EZ Scripts.

Part A: WC Industry Acronyms

  • Acronyms for worker's compensation: Defines and lists various acronyms like AWW, DOI, FCE, FROI, IME, IR, IW, MMI, NCM, and many more.

Part B: Internal (EZ Scripts) Acronyms

  • Abbreviations for EZ Scripts: Defines the abbreviations of internal processes and software at EZ Scripts, such as CS, EZRX, KPI, PPS, PrimeRx, RS, SF, and SP.

Part C: Medical Acronyms

  • Medical acronyms: Defines medical terms using acronyms like CARF, CDC, CI-CVI, DME, DO, Dx, EHR, EMR and more. These acronyms are arranged alphabetically.
  • Legal abbreviations: Lists legal acronyms such as ADR, ALJ, IF, LOMN, LOP, MSA, MVA, PI, SOL, and SSD, in alphabetical order.

Part E: Pharmacy Acronyms

  • Pharmacy acronyms: Lists pharmacy related abbreviations like a.c., a.q., b.i.d., DAW, d.c., and more, organized alphabetically.

Addendum #1 - State Specific Terms (Virginia)

  • Specific terms for Virginia concerning worker's compensation claims. These terms detail specifics related to Virginia's Worker's Compensation regulations.

Addendum #2 - Link to VA's WC Administrators

  • Link to the Virginia Worker's Compensation Commission website.

Addendum #3 - Links to your state's Worker's Comp Administrator's annual report

  • Links to specific report documents from Virginia's Worker's Compensation Commission.

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Worker's Compensation Terminology & Acronyms PDF

Description

This quiz covers essential terminology and acronyms related to worker's compensation. It provides definitions and descriptions for key terms, including Average Weekly Wage, Claimant, and Maximum Medical Improvement, among others. Test your knowledge of the specific language used in the WC industry.

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