Worker's Compensation Terminology & Acronyms
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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.</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.</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.</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.</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</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</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</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</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.</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</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</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.</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.</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</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</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</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</p> Signup and view all the answers

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

    <p>Back injuries</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.</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.</p> Signup and view all the answers

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

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

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

    <p>Joint Claim Number</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.</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.</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.</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.</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.</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.</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.</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.</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.</p> Signup and view all the answers

    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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