Find plain English definitions for workers’ compensation legal terms by browsing the Injured Workers’ Law Firm dictionary. If you need additional assistance please feel free to contact us.
The order from the VWC notifying the employer and workers’ compensation insurance carrier that a Claim for Benefits has been received seeking specific benefits and asking the workers’ compensation insurance carrier to indicate whether the carrier has sent agreement forms, is going to send agreement forms, agrees to a medical only award, or is denying the claim. They need to respond within 20 days of the Order.
Fees a claimant’s attorney can collect from a medical provider for efforts expended in getting the injured worker’s medical bill(s), that were denied by workers’ compensation insurance, paid by workers’ compensation insurance.
The maximum time limit allowed to receive workers’ compensation lost wage benefits, in most cases, in Virginia.
Adjuster – The representative who works for the workers’ compensation insurance company and administers its’ policies. This is typically the person the injured worker will be dealing with regarding his or her claim (unless an attorney has been hired by the workers’ compensation insurance company), as the adjuster is the person who has to approve or deny any medical care and/or payment for time lost from work.
Alternative Dispute Resolution – In workers’ compensation cases, this is a way of resolving disputes between two or more parties using a mediator to assist the parties in resolving the issues in dispute. This refers to the mediation of one or more issues in contention between the parties but will not result in a full and final settlement of the claim.
A written statement confirmed by oath or affirmation for use as evidence in court.
A fixed sum of money paid to someone each year, typically for the rest of their life
A letter or other document filed by the party unhappy with the decision of the court and asking the next highest court to review the lower court’s findings.
One of the requirements of an injury to have it determined to be compensable. This means that the injury suffered by the worker “originated from” or “grew out of” or “flowed from” or “was done in connection with” the injured workers’ employment. It requires some causal connection between the action(s) and the injuries suffered.
Fees paid to an attorney for services rendered.
A form that the workers’ compensation insurance company creates and mails to the injured worker to sign and return that indicates what benefits they are agreeing to pay to the injured worker. Once you have signed and returned it, the insurance adjuster will then sign and send the Award Agreement to the Commission for approval and entry of an Award Order.
An Agreement form(s) outlining which specific periods and dates the carrier is agreeing to pay an injured worker. These can be several different periods of time that vary in length (you often see this when an injured worker has been in and out of work due to his or her injuries).
(Also Award) A document from the VWC that specifically sets forth what the injured worker is entitled to (like lifetime medical benefits for specific body parts and/or payment for lost wages). This document is enforceable under Virginia law. This is the document that needs to be CORRECT (body parts, dates, amounts) in order to protect injured workers from time limitations on benefits in Virginia.
Average Weekly Wage – Your gross pay prior to any deductions per week based upon an average of the 52 weeks gross wages prior to your work accident, not the date you last worked. If you only worked 6 months, then you would only use 26 weeks. You add up all the gross wages earned for the last 52 weeks and then divide by 52. It gets more technical if you only worked for 1 or 2 days, so talk to an attorney if you are in that situation. You want this number as large as possible since it affects everything – how much you get weekly, how much you get in permanent disability, how much your check increases each year for the cost of living adjustment, and how much of a settlement you may receive. This figure should also include any bonuses, overtime, uniforms, meals, etc. This is how the Virginia Workers’ Compensation Commission (VWC) determines your compensation rate (Comp Rate).
A billing made to collect an expense incurred in a previous billing period. A back charge may be an adjustment due to an error, or it may be to collect an expense that was not billable until a later period due to timing issues.
A letter sent to medical providers and/or collection agencies informing them that the bill is related to a claim filed with the VWC and to stop all collection actions for medical debt against the injured worker as required by the statute.
The practice of a healthcare provider in which a patient is billed for the difference between what the patient’s insurance chooses to reimburse and what the medical provider chooses to charge (for example, if the injured worker is on Medicare after settling their claim).
Claim for Benefits – The form that the injured worker has to fill out and file with the VWC to formally request their benefits and protect themselves from the Statute of Limitations (SOL).
A form filed with the VWC to notify the VWC and all other parties that someone’s (usually the injured worker’s) official address of record has changed and that all future correspondence should be sent to that address.
Change in Condition-The term used to describe events which occur after an injury which affect the injured worker’s right to receive continued benefits. Certain standards have been established by the courts in determining what events constitute a change in condition.
(Also Injured Worker/IW) – The person injured at work or person seeking benefits through the Virginia workers’ compensation system.
An Award entered by the Commission for a specific closed period of time.
Centers for Medicare & Medicaid Services
Cost of Living Adjustment – A small annual increase in benefits based on the rate of inflation/increase in the consumer price index. Eligibility for COLA is based on the date of injury and the date of any last TTD paid pursuant to an Award Order and whether or not the injured worker is receiving Social Security Disability (SSD) benefits. (Injured workers collecting SSD benefits will usually not be eligible for COLA).
Virginia Workers’ Compensation Commission
Compensation Rate – The rate which workers’ compensation benefits are paid to the injured worker. It is usually 2/3rds of your average weekly wage. (You multiply your average weekly wage by .6667%). However, there are minimum and maximum compensation rates that increase every year, so if you have questions about whether you are being paid the correct amount, talk to an attorney.
Cost containment in workers’ compensation refers to the argument between the workers’ compensation insurance company and the medical providers regarding how much the carrier must pay the provider for services rendered.
A stenographer who creates word-for-word transcriptions at hearings, depositions, and other legal proceedings.
A large group of conditions that result from traumatizing the body in either a minute or major way over a period of time. It is an injury that occurs over a long period of time, rather than suddenly and all at once.
Deputy Commissioner (Also Commissioner) – The official residing over Virginia workers’ compensation hearings who makes rulings and decisions on claims and whether or not claimants are entitled to benefits based on the evidence presented at the hearing. He or she operates the same as a judge in other courts.
An individual, company, or institution sued or accused in a court of law. (For workers’ compensation purposes, this is the insurance carrier and/or employer)
The attorney who typically represents the interests of both the employer and the workers’ compensation insurance carrier during the workers’ compensation litigation process.
The letter sent by the injured worker to the workers’ compensation insurance carrier in settlement negotiations that lays out what relief the injured worker is seeking and the reasoning behind this.
(Also Depo) Recorded testimony. Generally, this is a question and answer session, under oath, where opposing counsel verbally asks the claimant questions and the claimant’s answers are recorded by a court reporter. This is a mandatory part of the pre-trial “discovery” process. Defense attorneys usually try to use inconsistencies in depositions against an injured worker and may then file the deposition transcript with the Commission.
This is when the Deputy Commissioner looks at the scarring or disfigurement resulting from an injury or from treatment related to an injury, and then the Deputy Commissioner determines the extent of the scarring or disfigurement to calculate how many weeks of compensation to award an injured worker for the scarring for disfigurement. The Code of Virginia allows for a total of 60 weeks of compensation for a scarring or disfigurement rating. The number of weeks allowed by the DC is then multiplied by the injured worker’s compensation rate to determine the amount owed for the rating.
Date of Accident/Date of Injury/Date of Loss- The date the work injury occurred.
A request made by the employer or workers’ compensation insurance company for the VWC to stop certain (or all) benefits provided to an injured worker. Both the injured worker and his attorney must be copied on both the Employer’s Application for Hearing along with the attached evidence. There are certain rules governing when benefits can stop. If the VWC deems the evidence is sufficient, the employer or workers’ compensation insurance company can then stop benefits until a hearing is held on the issues raised in the application.
Functional Capacity Evaluation – A lengthy exam, typically performed by a physical therapist at the request of the workers’ compensation doctor, used to determine a person’s permanent limitations that result from a work place injury. The insurance carrier pays for this evaluation if it is to determine the claimant’s ability to return to work. This evaluation may also provide a rating for the Permanent Partial Disability (PPD). However, many FCE’s are performed without issuing an impairment rating. To get the impairment rating only, the injured worker must pay for the FCE.
Full Duty – The ability to at least perform the duties of your pre-injury job, if not being released to work without any medical limitations. It may mean returning to your prior job but returning to your prior job is not a requirement.
Family and Medical Leave Act – Job protection for time out of work for up to 12 weeks (may not apply to everyone). This is unpaid leave from work.
First Report of Injury – The form used by employers or insurance carriers to notify the VWC that an injury has occurred. This form can also be used for statistical reports.
When a party is unhappy with the Opinion (or ruling) of the DC, they can file an appeal which is called a Request for Review. Once filed, the Commission will send all parties a Schedule for Written Statements (basically deadlines for all evidence and paperwork) and, once the written statements are received, the Commission will review everything and issue their Opinion (or ruling) and all parties will be notified by mail. The time between the filing of the Statements and the Opinion is lengthy.
Work that a person performs for wages or activities intended to provide an income to a person. This term is very vague and can be interpreted in many ways.
The official court appearance presided over by a DC in which the injured worker and the insurance carrier and/or their attorneys present their arguments as to why the injured worker is or is not entitled to receive workers’ compensation benefits and questions are asked of all witnesses.
The ability to do or withstand unusual strain in the workplace.
Health Insurance – This is personal health insurance coverage that you have or you pay for. Treatment for work related injuries should only be put through health insurance if your claim has been officially DENIED by workers’ compensation insurance. The best advice is talk to an attorney on how to handle this situation.
Independent Medical Exam – An exam an injured worker is mandated to attend at the request of the workers’ compensation insurance company to allow the insurance company to get an evaluation by a doctor of its’ choice for a second opinion. Generally, the IME doctor gives a written opinion on whether the current medical treatment is related to the work accident, evaluates the Claimant’s current condition, and determines a selected course of medical treatment. Generally, the IME doctor will not discuss his or her findings with the injured worker. The examiner may write a report at the request of the workers’ compensation insurance carrier with his or her findings being sent to the insurance carrier for review (if it is a negative report against the injured worker). If the IME doctor agrees with your treating physician, the workers’ compensation insurance carrier will request that the IME doctor not put his or her findings in writing. Usually, the adjuster or their attorney calls the IME doctor and requests that it is not put in writing. There is no doctor-patient privilege and this doctor will not give any advice to the injured worker.
One of the requirements of the injury is to have it determined to be compensable. This means that the injured worker was involved in the tasks and circumstances of a workers’ job and was doing their job or actions related to completing work tasks when they were injured.
Injured worker – Person injured while at work.
This term refers to an identifiable incident or sudden precipitating event that results in an obvious sudden mechanical or structural change in the body.
Insurance Carrier – The workers’ compensation insurance company that is administering and processing the claim for workers’ compensation benefits.
(Also Rogs) – Written testimony. Generally, this is a list of questions given from one party in a claim to another in order to gather information relevant to the issues of the case. This is a mandatory part of the pre-trial “discovery” process. Interrogatories can be used against either party at a deposition or a hearing. Information and facts not mentioned in the Interrogatories cannot be raised at the hearing.
Light Duty -– Generally, this means the ability to work in some capacity, just not full duty. The Department of Labor and most vocational rehabilitation counselors use this term to specifically mean within certain limitations as set forth by a doctor. This can also mean the ability to lift up to 10 lbs.
An interest in the workers’ compensation funds (child support, 3rd party, prior attorney, PI claim)
Long Term Disability – Disability benefits paid through one’s private insurance or provided through his or her employer that furnishes pay for an extended time out of work, usually not related to workers’ compensation injuries. LTD typically begins after a disability has lasted for a period of 6 months but can vary depending on the individual policy.
The requirement to look for light duty or modified duty work while you are under the care of a doctor who has placed limitations on your current work abilities and your employer has no work available that is within the restrictions given. This also refers to the documents kept by the injured worker to clearly track these attempts at finding employment within the work restrictions given by the physician. This will be required even if the injured worker is still employed with their employer but the employer has no light duty work available.
“A U.S. government program financed by federal, state and local funds, of hospitalization and medical insurance for persons of all ages with certain income limits.” (source http://dictionary.reference.com)
Also, medical case management. “This refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include assistance in developing, implementing and coordinating a medical care plan with the injured worker’s doctors, as well as the employee and his/her family, and evaluation of treatment results. In workers’ compensation cases, the person performing the medical case management is usually a nurse hired by or employed by the workers’ compensation insurance company for the workers’ compensation insurance company’s benefit.” (Source: Wikipedia.com)
An Award from the VWC ordering that the workers’ compensation insurance carrier be responsible for care to listed body parts in relation to the work place accident.
This is a claim that a medical provider files with the VWC in a workers’ compensation case when the insurance company has paid for part of the medical treatment rendered but has not paid the entire bill. This is filed in accepted cases and the injured worker is usually not involved in the disagreement.
“A U.S. government program of hospitalization insurance and medical insurance for persons aged 65 and over for certain disabled persons under 65.” (source: http://dictionary.reference.com)
The injured worker will be able to obtain Medicare benefits, whether due to age or disability, within the next 30 months. This is one of the criteria used to determine whether a Medicare Set-Aside (MSA) is needed to settle a case.
Medium and light duty work limitations usually are applied in manufacturing and construction jobs which require significant physical activity. A person who does significant physical labor in their regular job might be able to perform a medium duty job of standing at a palletizing machine and pulling levers.
The monies reimbursed to an injured worker for his or her travel expenses to and from medical appointments for treatment of his or her work injuries.
Maximum Medical Improvement – When an injured worker reaches a treatment plateau where his or her condition(s) cannot be improved any further. This can mean full recovery or that the doctor has stated that there is nothing more that can be done for the injured worker with any expectation of significant medical improvement. It does not necessarily mean that treatment has ended.
Medicare Set Aside – A document prepared by a third party explaining how much of the injured workers’ future medical treatment that Medicare would have to pay if the workers’ compensation carrier was not involved. This can also refer to the funds Medicare requires, in certain cases, to be allocated out of an injured worker’s settlement to pay for future medical services related to the workers’ compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.
Nurse Case Manager – An administrator hired by the insurance company to oversee the care, progress, recovery, and work ability of the injured worker. The NCM will attend the doctor’s appointments and be an active part in the injured workers’ medical care. Don’t forget to ask to have your examination with the doctor in private!
Notice of Representation – The formal notice that an attorney files with the VWC to inform all parties that he or she is now representing the injured worker or the workers’ compensation insurance carrier.
A disease or disorder that is caused by the work or working conditions. This means that the disease must have developed due to exposures in the workplace and that the correlation between the exposures and the disease is well known in medical research.
The offer made by the employer or workers’ compensation insurance carrier to settle a claim in a lump sum, usually in response to a demand or intended to solicit a demand.
Out of Work/Off of Work – When a doctor has taken you completely out of work due to your injury. This means you are unable to do any work at all, not just your specific job duties.
An Award entered by the Commission for an open period (no end date).
(or Ruling) A decision made by a Deputy Commissioner regarding a claim after a hearing or OTR hearing.
Occupational Safety and Health Act – This is the entity in Virginia that regulates employers and work safety – workers’ compensation does not address this.
On the Record Hearing – An Opinion (or ruling) made by a DC with no formal hearing/court appearance after review of the evidence.
The list of approved workers’ compensation doctors that the workers’ compensation insurance carrier provides to the injured worker from whom the injured worker can seek medical treatment for their work injury.
A set of documents necessary to be filed in workers’ compensation settlements. The Petition is signed by all parties and explains what settlement agreement the parties have reached. The Order is the document prepared by the parties that explains the settlement agreement reached and it is the document that is signed by the Deputy Commissioner indicating an approval of the agreement.
The document that sets out the legal stance taken by a party on a particular legal issue.
The average wage an injured worker is earning after his or her injury. This is calculated by averaging the post-injury gross wages.
Permanent Partial Disability – An award for the permanent loss of use of certain body parts specifically listed by the General Assembly in the Virginia Workers’ Compensation Act (usually extremities only – the neck and back are not covered), based on the rating of loss of use (also known as impairment rating or disability rating) given by the medical professional, as determined by the Functional Capacity Exam/FCE. (see blog Workers’ Compensation Terms – Part 1 – The Medical Lingo for more on the FCE). There is a very specific math formula to calculate the monetary value: the comp rate multiplied by the number of allowable weeks for that specific body part, multiplied by the percentage disability rating, as set forth in the Code of Virginia. This can also be referred to as the Loss of Use Rating.
(Also, Request for Production of Documents) – A legal request for documents, electronically stored information, or other tangible items pertaining to the subject matter being litigated in the hearing process. This is a mandatory part of the pre-trial “discovery” process. The documents turned over, or produced, can be used at a hearing by either party at the hearing. Documents not produced cannot be used at a hearing and will not be considered by the DC when he or she is making his or her decision.
Permanent Total Disability – Benefits awarded in a very limited and specific set of circumstances in which an injured worker has permanent loss of use of at least two extremities. The benefit provides lifetime medical and wage benefits. This requires permanent loss of use of both hands, both arms, both feet, both legs, both eyes, or a combination thereof, or total paralysis) that keeps the injured worker from using the body parts in gainful employment. Or, when the injured worker suffers a from a severe brain injury that leaves the worker permanently unable to work or find gainful employment. This benefit is paid for the rest of the injured workers’ life.
A recorded statement the workers’ compensation insurance carrier may take from the injured worker detailing how the injury occurred. This statement can and will be used against the injured worker any time throughout the workers’ compensation litigation process.
(Also, sometimes also called a request to admit) – A set of statements sent from one litigant party to another for the purpose of having the other party admit or deny the statements or allegations. Requests for Admission are part of the pre-trial “discovery” process and are intended for use at a hearing.
A legal request for documents, electronically stored information, or other tangible items. These are requested during the pre-trial “discovery” phase.
A document that is filed that is an objection to the court’s formal Opinion (or ruling) and asking the courts to correct an oversight.
Return to Work – This is when the doctor releases an injured worker to return to any form of work. This can be at a full duty or light duty status.
The formal rule of the VWC that all parties must make all medical records related to the claim available to the opposing party and, in some cases, to the VWC. Rule 4.2 reads: “Each party shall promptly provide the other parties with copies of any medical records they receive as they receive them. Unless otherwise directed by the Commission or these Rules, the parties shall not file medical records with the Commission until a hearing request is filed. The requesting party shall promptly file medical records supporting the request, if applicable. After a hearing request has been filed, the parties shall file with the Commission only medical records that are related to the hearing request. These records shall be filed upon receipt by the party filing them, and are required reports subject to the provisions of 65.2-902. A party is not required to file copies of medical records that another party has already filed.” (source: http://www.workcomp.virginia.gov)
A form of light duty work that typically requires the worker to be seated. This type of job also usually has weight restrictions of no lifting over 5 or 10 lbs.
Another name for a light duty job either working for the pre-injury employer or a job found by the pre-injury employer when the injured worker can work but cannot perform his or her pre-injury job.
Closing of a claim for an agreed upon lump sum.
Another comparable employee (i.e., has been doing the same work, has the same job title, the same credentials). The wages of a similarly situated employee can be used to determine the AWW of an injured worker who has only been working for the employer for a short period of time, usually a time not long enough to determine his or her AWW by using his or her own pay stubs.
Special language included in settlement documents to protect the injured workers’ future SSD benefits from being reduced based on the workers’ compensation settlement.
Statute of Limitations – Very strict time limits placed on injured workers by the State of Virginia restricting how much time they have to request certain benefits.
Supplemental Report of Injury – A quarterly report filed by the insurance carrier outlining benefits paid for lost wages and medical expenses related to the injured worker’s claim.
Social Security – “A United States federal program of social insurance and benefits developed in 1935. The Social Security program’s benefits include retirement income, disability income, Medicare and Medicaid, and death and survivorship benefits. Social Security is one of the largest government programs in the world, paying out hundreds of billions of dollars per year.” (source: http://www.investopedia.com)
Social Security Administration – An agency of the United States federal government that administers and regulates benefits paid through Social Security, headquartered in Woodlawn, Maryland.
Social Security Disability benefits – A federal program funded through payroll taxes that pays benefits to individuals who have been injured.
Supplemental Security Income – A need based program in the form of a monthly check which is according to income and assets that provides disability benefits for low-income disabled people who don’t qualify for SSD.
Social Security Retirement Income – Income based on the average amount of wages earned over a workers’ lifetime that is then paid to them monthly after the worker has reached retirement age. SSD can be converted to SSR when the worker reaches retirement age.
Short Term Disability – Disability benefits paid through one’s private insurance or provided through his or her employer that furnishes pay for time out of work, usually when it is not related to workers’ compensation injuries. STD is typically paid for a period of 6 months but can vary depending on the individual policy.
A legal settlement paid out as an annuity rather than in a lump sum, usually with certain tax advantages for the recipient and a savings for the payer.
Is a writ issued by a government agency, most often a court, to compel testimony by a witness or production of evidence (documents) under a penalty for failure. There are two common types of subpoenas: Subpoena ad testificandum orders a person to testify before the ordering authority or face punishment. The subpoena can also request the testimony to be given by phone or in person. Subpoena duces tecum orders a person or organization to bring physical evidence before the ordering authority or face punishment. This is often used for requests to mail copies of documents to the requesting party or directly to court.
The termination of employment due to an employee’s action or error in judgment.
The agreement form reflecting when an injured worker was released to return to work that is signed by all parties and filed with the VWC. This form indicates that the injured worker has been released to return to some form of employment and, therefore, terminates the weekly benefit check but not the medical benefits.
(Also called the workers’ compensation doctor or workers’ compensation treating physician) The approved doctor currently treating an injured worker for his or her work related injuries. Not to be confused with your Family Physician (FP) or Primary Care Physician (PCP).
Temporary Partial Disability- Benefits awarded when the injured worker is able to work in some capacity but not full duty and is getting paid less than before he or she was injured. Pay for partial time missed from work or for earning less due to the work injury. For example, if you were making $25 an hour when you got injured and then returned to work on light duty making $9 an hour, you could receive TPD compensation to make up for the lost income.
Temporary Total Disability – Wages for time missed from work when the injured worker has missed more than 7 days and the injured worker is not working. This can be due to either being taken totally out of work or being given work restrictions that prevent the injured worker from returning to his or her pre-injury employment.
Termination of Wage Loss Award – A form that the workers’ compensation insurance company creates and mails to the injured worker to sign and return that indicates that the injured worker has been released to return to some form of employment and, therefore, terminates the weekly benefit check but not the medical benefits. Once you have signed and returned it, the insurance adjuster will then sign and send the TWLA to the Commission for approval and entry of an Award Order.
“A source of income for workers who have lost their jobs through no fault of their own. Workers who quit or are fired are generally not eligible for unemployment insurance. Workers who are self-employed are also not eligible to receive unemployment insurance and must provide their own rainy-day funds to cover times when no work is available.” (source: http://www.investopedia.com)
A fund held by the Virginia Workers’ Compensation Commission that is used to pay for lost wages and benefits of injured workers whose employer did not carry workers’ compensation insurance.
Vocational Rehabilitation – A program that the insurance company uses to restore the injured worker to some form of employment.
Vocational Rehabilitation Counselor – The person who will oversee and assist the injured worker with job searching/marketing and, in some cases, resume revision to assist the injured worker in finding some form of employment.
Virginia Workers’ Compensation/Virginia Workers’ Compensation Commission – The state entity, separate from the insurance company, that oversees the administration of workers’ compensation benefits and, when appropriate, schedules hearings for workers’ compensation issues to be litigated.
A chart or table that shows an injured worker’s gross wages for the 52 weeks prior to the work injury which is used to calculate the AWW.
The online tool at http://www.workcomp.virginia.gov/ that allows injured workers, workers’ compensation insurance adjusters, and attorneys to view, print, and file documents related to the claim.