Common Workers Compensation Definitions and Acronyms (I-W)

Posted on Monday, December 10th, 2018 at 9:27 am    

This is the second part of a summary of common medical acronyms and terms. These definitions apply to many aspects of an employee’s workers compensation case:

  • IME. Independent medical examination. This is an evaluation performed by a non-treating doctor. It is usually requested by the employer to evaluate whether a worker is ready to return to work. Often, the IME doctor is hired by the employer and works to show the employee is ready to return to work, or that a treatment recommended by your authorized treating doctor is not medically necessary. It is essential that an injured worker prepare for the IME exam beforehand with an experienced North Carolina or Virginia work injury lawyer. The attorney can explain what takes place at the exam and what the employee is required to tell the IME doctor. The lawyer will usually contest the IME doctor’s report through the worker’s own treating physicians. In North Carolina, An IME can also be requested by an employee to show the current doctors aren’t helping the worker – and that the worker should have the right to switch to a new physician.  
  • Indemnity benefits. These are generally the non-medical payments – including temporary total disability pay, permanent partial disability benefits, permanent total disability benefits and death benefits.
  • IR. Impairment rating. Also known as PPI or permanent impairment rating. Workers are entitled to treat with physicians, therapists, and other health providers as long as they are helping the worker get better. At a certain point, most workers reach the level of maximum medical improvement. This is the point where additional medical care won’t help improve the employee’s medical condition. At this point, the worker will be examined by the treating physician to analyze if he/she has a permanent disability. The seriousness/level of the disability is then given a percentage impairment rating.
  • For example, the doctor may say the ability to hear is only 40% of what it was prior to the accident or the impairment rating of the ability to use a left leg is 30% of what it once was. In Virginia, for instance, a 30% impairment rating of the leg would equate to 52.5 weeks of comp checks. So, if the worker had a weekly comp rate of $500.00, that would be $26,250.00.
  • But it should be noted that no matter how high the rating is, sometimes the impairment rating is really not significant in terms of the value of the claim. For instance, if the worker is unable to return to his or her job due to his injuries, and he or she is still receiving comp payments each week, then he or she can in any event usually only receive a maximum of 500 weeks of benefits. The additional weeks provided by an impairment rating are not allowed to increase the 500 weeks. In addition, under Virginia Law, one cannot receive temporary total disability (TTD or comp payment) benefits at the same time as permanent impairment benefits.
  • So, in our example of the 30% leg rating of a person who remained out of work, could not return, and was still receiving his TTD benefits, the 30% rating would not matter, because we’d really be looking at the 500 weeks and that’s it. On the other hand, if the worker had returned to either full duty or a job paying the same as the pre-injury wage, or even a lesser-paying job, then the he or she would be entitled to receive the impairment rating.
  • The other reason an impairment rating can be important is if the injured worker has received a rating to two or more ratable body parts. If that is the case, and the ratings interfere with the worker’s ability to work, then it is possible that a permanent and total finding may be made by the Commission, which could entitle the employee to lifetime benefits, not just the 500-week benefits. For instance,
  • LE. Life expectancy. This is the number of years the worker is expected to live based on his/her age, gender, and physical condition. It is used when lump sum payments are being considered. Essentially, a worker’s yearly wage loss and yearly medical bills are multiplied by his/her life expectancy to get the cost of future benefits. These numbers are set by statute in both Virginia in North Carolina.
  • MMI. Maximum medical improvement. This determination is made by a physician. It essentially is the time when additional medical treatment won’t help the patient get any better. When a worker reaches MMI, the impairment ratings of any permanent impairments are typically analyzed and oftentimes, the treating physician may order a functional capacity exam (FCE) to determine the worker’s permanent physical restrictions. MMI does not end medical benefits. Injured or ill workers may still need regular checkups, treatments and therapies so a condition doesn’t worsen, and medical devices and prescriptions. The employer’s insurance carrier should pay for these long-term medical costs.
  • MSA. Medicare Set-Aside Agreement. MSAs are usually considered when a worker wants to enter into a lump-sum settlement and is a currently-qualified Medicare recipient. In the workers compensation context, these are usually folks who have been determined to be disabled by Social Security for more than 24 months. Those people automatically qualify for Medicare coverage after the 24 months elapses. The gist of the concept of an MSA is that the worker may not “double-dip”. One cannot receive a sum of money for future medical care from the carrier in settlement and then turn around and utilize their Medicare to cover the same injuries. The worker is required to protect Medicare’s interests. The employer’s insurance company will generally obtain a Medicare-Set Aside Report. That report is then sent off to CMS, the review office for Medicare, and they will either approve the suggested set-aside amount, or suggest a different amount. The MSA essentially sets aside the sums that the settlement will use for medical bills so the Medicare isn’t required to pay those expenses. The MSA is usually funded by an annuity purchased by the workers comp carrier, which annuity will pay out a seed amount in the first year and then a set amount each year thereafter for the worker’s life expectancy to cover the injury-related medical expenses that Medicare would normally cover.
  • NCM. Nurse Case Manager These people work for the insurance company. On the surface, they are trying to help workers schedule their medical appointments and get to their appointments on time. On the surface, they are available to answer questions workers have about their medical care and prescriptions. The reality is that they are working to get you back to work as soon as possible. They often look for workers to miss appointments or fail to take medical advance – and then help their employer try to terminate your benefits. Workers should review with skilled work injury lawyers exactly what case managers can and can’t do. For example, while CMs can help you get to your appointment, they do not have the right to be in the room when you are being treated by a physician.

 

 

 

    • PTD: Permanent and total disability. Some workers can never return to work. Workers who lose both eyes, hands, arms, legs, or feet (or a combination of two) can claim permanent total disability benefits. Also severely brain-injured workers and workers with severe burns may qualify for permanent and total disability. These benefits cannot be claimed until the worker approaches the end of his or her 500 weeks. Then the Commission makes the assessment as to whether or not the work injury qualifies for permanent and total to go beyond the 500 weeks into lifetime benefits.  In North Carolina, in addition to the categories of injuries mentioned above, after an injured worker reaches 425 weeks of TTD benefits, he or she may make an application for extended benefits beyond the 500 weeks by showing a “total loss of wage earning capacity” due to his or her work injuries. That being said, once the worker on extended TTD starts receiving Social Security Retirement benefits, there is a “set off” of 100% of the retirement benefits.
    • PT. Physical therapy. Workers often need many different types of therapy so they can get better. Physical therapy focuses on helping the patient with physical injuries such as a sore back or rotator cuff injury to the shoulder. Other types of therapy include occupational therapy, speech therapy, and vocational therapy.
    • RSI. Repetitive stress injury. This is an injury that develops over months or years due to constant repeat pressure or motions. Carpal tunnel syndrome is a well-known RSI. It may be possible to claim worker’s compensation for an RSI though the employer will argue that it wasn’t due to an accident and isn’t an occupational illness. That being said, most other forms of repetitive stress injuries are not compensable under workers compensation law. A skilled work injury can explain when and how a claim for an RSI injury can be made.
    • SOL. Statute of limitations. All work injury claims must be brought within specific time periods or the claim will be forever barred. It’s important to see an experienced worker’s compensation lawyer as soon as possible so you meet this crucial deadline. Typically, one must file a claim within two years of the accident or one is forever barred from recovery.
    • TPD: Temporary partial disability. This term applies to workers who can return to some sort of modified or light duty work, but for less money than their pre-injury wage. The amount received is 2/3rds of the difference of their pre-injury and post-injury, light duty wage, for up to 500 weeks.

 

  • TTD. Temporary total disability. This is the term applied to the typical “workers comp check” benefit received by the injured worker each week. This term applies to an employee who can’t return to work at any level based on their doctor’s note, and it is typically 2/3rd’s of the injured worker’s average weekly wage, for up to 500 weeks.

 

    • Vocational benefits. Some workers may not be able to return to work at any job – but may be able to obtain new work if they are retrained. Vocational benefits pay for the cost of retraining this type of injured worker. Vocational benefits can include tuition, books, the cost to get to the training, and other related expenses.

 

  • Vocational Rehabilitation Counselor or VRC. This professional is knowledgeable about what work is available for specific skills in the region where the worker lives. The expert evaluates if work is available and what type of training is needed to that type of work. The vocational expert also reviews if the worker is capable of being retrained. Be forewarned that these experts are on the dole of the workers compensation insurance company. Their goal is often not to find you a job, but to make you “jump through hoops” in order to trip you up so that your benefits can be cut off. Going through vocational rehabilitation is usually a very annoying and frustrating experience. Sometimes, it is used to put pressure on the injured worker to settle their claim for a lesser amount. We usually advise our clients to simply endure the “game,” and play it, until we can get their case in a good position for settlement.

 

  • Workers’ compensation rate. This is the amount the worker is actually paid if the claim is approved. The starting point is 2/3 of the worker’s average weekly wage or .66667 of the pre-injury average weekly wage.

Don’t wait. Call the North Carolina and Virginia Law office of Joe Miller Esq., today. We have the experience and resources to help you get justice. You may have a large recovery coming your way. help now, phone 1-(888) 667-8295 or complete my contact form to discuss you work injury claim.