Glossary of Terms
Abrasion: A scrape, minimal bleeding with possible intense pain.
Actuary: One who calculates insurance and annuity premiums, reserves and dividends.
American with Disabilities Act (ADA): In 1990 the federal government passed the ADA Act. This was a clear statement by Congress that employers must not discriminate on the basis of disability.
Carpal Tunnel Syndrome (CTS): A cumulative trauma disorder involving compression of the median nerve.
Classification Codes: Codes use to categorize payroll into classifications which best describes an employee's job duties.
Compensable Injury: An injury or disease arising out of and in the course of employment.
Contusion: A bruise, resulting from trauma caused by coming in contact with a blunt object.
Coordination of Benefits (COB): Provisions and procedures of insurers used to avoid duplicate payments when claims are covered by more than one insurance policy.
Dependent: Any natural or legally adopted child residing at the same residence as injured employee who is under the age of 18, and/or any child certified legally handicapped over the age of 18.
Disability: A limitation of an employee's wage earning capacity in work suitable to his or her qualifications and training, resulting from a personal injury or work related disease. The establishment of disability does not create a presumption of wage loss.
Disability (as defined under Workers' Compensation):
Temporary-Partial: The injured employee is temporarily unable to perform some job-related tasks.
Temporary-Total: The injured employee cannot to any extent, perform their occupational duties, and the condition is not permanent.
Permanent-Partial: The injured employee has permanent disability caused by the injury to a body part (eye, foot, leg, arm, and hand). However, does not cause loss of gainful employment.
Permanent-Total: A condition where the employee has lost complete sight, or both hands or legs, regardless of whether or not they are able to perform work duties. The Workers' Compensation Act specifies the exact number of weeks of compensation to be paid by individual injury loss.
Displaced Fracture Repairs:
Closed Reduction: The manipulation through the unbroken skin of the broken bone to properly align. Sometimes weights and traction are used.
Open Reduction: Involves making a surgical opening over the fracture site and repositioning the bones, possibly using devices such as plates or pins to hold the bones together.
Employee: Every person in the service of another, under any contract of hire, express or implied.
Employers Liability Insurance: (Also may be referred to as "Part B.") Insurance that protects an employer against the claims for damages, which arise out of injuries to employees in the course of work. Employers Liability Insurance generally provides protection in employment related injury cases not covered by Workers' Compensation Law.
Estimated Payroll: Payroll submitted by an employer to the insurance carrier at the beginning of a policy period. This payroll is used to estimate a premium dollar amount, and is later updated with the actual/audited payroll for the period.
Exclusion: Something that is not covered by the insurance policy and specifically stated so in the policy contract. (For example: coverage may exclude your serious and willful misconduct; or your failure to comply with a health or safety law or regulation.)
Exclusive Remedy: The right to the recovery of benefits as provided in the Workers' Compensation Act shall be the employee's exclusive remedy against the employer for a personal work related injury or occupational disease. The only exception to this is an intentional tort.
Experience: A record of past actual payroll and losses (claims) for individual employers. This experience is the basis upon which future rates (costs) are predicated actuarially.
Experience Modification Factor: A calculation of past experience of an individual employer's actual losses compared to the expected losses of the average employer in the same industry.
Handicapped: Refers to the degree of functional limitation resulting from impairment. The existence of a handicap depends on the extent to which impairment impedes a person's function.
Hepatitis: Inflammation in the liver.
IBNR Reserve (Incurred But Not Reported): The reserve established for Incurred But Not Reported claims and claims development. It is established as a percentage of standard premium for the MHA W/C Fund by the Fund's actuary.
Idiopathic: Disease of unknown origin.
Impairment: An alteration in health status that is assessed in a medical context. Impairment does not automatically result in disability.
Incurred Claims: The total amount paid on claims plus any outstanding reserves (expected future payments).
Independent Medical Exam (IME): A medical exam performed by an independent physician. It includes a brief review of the patient history and treatment to date and a physical examination of the patient. The purpose of the examination is to assist the physician in making a medical determination as to causation, current physical impairment, and the necessity of current and future treatment.
Intentional Tort : An intentional tort exists only when an employee is injured as a result of a deliberate act of the employer and the employer specifically intended an injury. An employer is deemed to have intended to injure if the employer had actual knowledge that an injury was certain to occur and willfully disregarded that knowledge.
Job Analysis: A formal assessment of the physical demands of a particular job. This is determined through an on-site visit and guided by a comprehensive checklist of physical demands.
Job Modifications: A change in the physical demands, number of duties, emotional demands, and/or hours required in that job.
Laceration: A tear in the skin and may sometimes include other tissues.
Loss Fund: The portion of standard premium that is placed a pool or trust to cover payment of claims for each individual member as well as the Fund as a whole.
Malinger: To pretend to be ill or otherwise incapacitated in order to escape duty or work.
Manual Premium: The employer's payroll multiplied by classification rates.
Mediation: A hearing for a case where the injured party has concerns regarding his/her rights. The mediation can be held for claims concerning a definite period of time, a claim for medical bills only, a case where the injured party is not represented by an attorney, and if the bureau determines that the case may be settled through mediation. The bureau will review the case and advise the injured party with a concise explanation of his/her rights and responsibilities under the act, including a reasonable estimate of the maximum amount of benefits in which the injured party would be entitled to if the case was approved. At the mediation the parties involved are the carrier, injured worker, attorney (if any), and a mediator.
Mental Disability: Mental disabilities are deemed compensable when arising out of actual events of employment -- not unfounded perceptions thereof.
Neurologist: An expert in the treatment of disorders of the nerves and nervous system including the central nervous system (brain and spinal cord) and the peripheral nervous system (sensory and motor nerves throughout the body).
Occupational Disease: A disease which is due to causes and conditions which are characteristic of and peculiar to the business of the employer and which arises out of and in the course of employment. (An ordinary disease of life to which the public is generally exposed outside of employment is not compensable.)
Occupational Safety and Health Administration (OSHA): The agency responsible for promulgating rules, setting health and safety standards, and overseeing enforcement, whether by direct federal effort or by relying on state enforcement programs.
Occupational Therapist (OT): A therapist who evaluates the self-care, work and leisure skills of a person and plans and implements social and interpersonal activities to develop, restore, and/or maintain the person's ability to accomplish activities of daily living (eating, dressing, bathing) and necessary occupational tasks.
Orthopedist: A physician who specializes in the preservation and restoration of the function of the skeletal system (bones), its articulations (joints), and associated structures (muscles, tendons, ligaments).
Outstanding Reserves: The remaining amount set aside to pay future claim costs.
Personal Injury: A disease or disability, which is due to causes and conditions which are characteristic of and peculiar to the business of the employer and which arises out of and in the course of employment.
Physiatrist: A physician who specializes in physical medicine and rehabilitation.
Physical Therapist (PT): An individual trained or licensed to provide treatment to help injured people achieve maximum physical restoration through physical agents (heat, light, water, electricity, massage and exercise).
Physician Assistant (PA): A trained, licensed individual who performs tasks that might otherwise be performed by physicians or under the direction of a supervising physician.
Prosthesis: Designs and fits artificial limbs for individuals who have suffered an amputation.
Psychiatrist: An individual who treats people through counseling to overcome emotional and psychological reactions to an injury or disease. One difference between a psychiatrist and psychologist is that the psychiatrist is a licensed medical doctor can prescribe medication.
Psychologist: An individual who treats people through counseling in an attempt to help overcome emotional or psychological reactions to injury or disease.
Radiographic Tests:
Computerized tomography (CT Scan): A pinpoint x-ray beam directed on horizontal or vertical planes of the brain. These slices are then fed into a computer, which analyzes and displays them for diagnostic purposes.
Electromyogram (EMG): Referred to as a nerve conduction study, used to identify nerve damage.
Magnetic Resonance Imaging (MRI): Uses a combination of a huge super-conductive magnet, electromagnetic waves, and a sophisticated computer system to create very detailed images of the body's interior.
Myelogram: Air or contrast medium is introduced into the subarachnoid space surrounding the spinal cord and nerve roots. It is used to diagnose ruptured discs, space occupying lesions, or pressure from bone fragments or overgrowth.
Redemption: After 6 months' time has elapsed from the date of injury, any liability resulting from the personal injury may be redeemed by the payment of a lump sum by agreement of the parties, subject to approval of a hearing referee. A hearing referee or workers' compensation magistrate must approve a redemption agreement.
Remuneration: Payment made for services rendered to an employer. Remuneration includes the following:
- Commissions
- Bonuses
- Extra wages for all overtime work at regular rate.
- Wages for holidays, vacations, or sickness periods.
- Payments by the employer of contributions required by law to statutory insurance or statutory pension plans such as the Federal Social Security Act, which otherwise would be paid by the employee.
- Payments to employees made on any basis other than that of time actually engaged in work, including but not limited to piece work, incentive plans or profit sharing arrangements.
- Payments or allowances to employees for hand or power tools furnished by employees.
- Payments made by the employer to defined contribution programs such as: Section 125 cafeteria plans, 401(k)'s, 403(b)'s, etc.
Reserves: An amount placed on an individual claim to cover expected future payments for that claim.
Return to Work Release: A physician's approval for an injured employee to return to some level of gainful employment. This may be restricted or full duty.
Settlement: A settlement occurs when both parties agree on a said amount and a magistrate approves the settlement (redemption). A settlement can be either a lump sum or a structured payment.
Spondylolisthesis: Manifested by an increase in lumbar curvature or by a chronic low back pain with occasional lightening of the hamstring muscles.
Spondylolysis: Is either a unilateral or bilateral stress fracture in the isthmus of the spinal process with no slippage of the vertebrae.
Sprain: To wrench or twist a ligament or muscle, usually in a joint. An injury resulting from this is characterized by swelling, pain, and disablement of joint.
Standard Premium: Manual premium multiplied by employer's experience modification factor.
Strain: To draw or stretch tight a ligament or muscle. Results from working a muscle beyond its normal capacity.
Structured Settlement: This is a settlement where the injured party may receive some of the money owed up front and the remaining is paid in installments, (i.e. annually, semiannually, quarterly).
Subrogation: Subrogation may be involved in the case of an injury for which compensation is paid under the Workers' Compensation Act and the circumstances caused a legal liability in some person other than the employer. If the injured employee settles his case, any recovery against the third party for damages resulting in personal injury, after deducting expenses of recovery, may be used to reimburse the carrier, with the balance forwarded to said injured party.
Tests of Function or Performance:
Lasegue's Signs: The physician raises the straightened leg of the patient. This puts pressure on the sciatic nerve and pain can indicate the presence of a herniated disc.
Transferable Skills: One's abilities which can be applied equally from one job to another.
Utilization Review (UR): Evaluation of the necessity, appropriateness and efficiency of the use of medical services and facilities.
Vocational Rehabilitation (Voc Rehab): An entitlement of an injured employee to receive prompt medical rehabilitation and/or retraining or job placement, as may be reasonably necessary to restore him or her to useful employment.
Work Hardening: A technique that assists an injured employee to gradually readjust to the physical demands of a job. The injured employee practices job-related tasks using less weight, a shorter period of time, or slower pace than is required in the actual job.
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