Now that you have landed in the complicated world of workers' compensation, you may begin to hear words, phrases or acronyms that are unfamiliar. It can be overwhelming to receiving information containing legal jargon.
Frequently, when we communicate with potential clients, they will tell us that they talked to "workers' compensation." There is no one person or one entity that is "workers' compensation." Sometimes when we are told "workers' compensation won't do this" or "workers' compensation told me I don't have to file that," it is difficult to figure out if "workers' compensation" is the insurance carrier for the employer, the Industrial Commission of Arizona, human resources, or another attorney. When you can't identify the person or entity that is giving you information about your claim, that is an issue because you don't know if the person or entity you are talking to is on your side, on the opposing side, or neutral. Just like it is important to be able to accurately identify what entity you are talking to, it is important to be able to correctly identify what type of treatment you are receiving and what your work status is.
Fendon Law Firm believes that it is extremely important that everyone understand exactly what is going on with their claim so we have put together this list of terms. If you have questions about these concepts or about your workers' compensation claim, please call us for a consultation. We offer a free case evaluation so you can get started now at no cost to you! At Fendon Law Firm we treat you like family because we are family.
Definitions of Words Used Often in Workers' Compensation:
ACTIVE MEDICAL CARE: Means any medical treatment designed to improve your condition or make you better. For example, surgery and trigger point injections can be active medical care.
AVERAGE MONTHLY WAGE (AMW): Means the amount of money that you make per month. It is usually calculated using your actual earnings in the 30 days before the date of injury. However, it is possible that it can be calculated by looking at an expanded wage base. That would mean looking at longer periods of time, for example how much you averaged each month in the last year or since you started working for the company.
AWARD OR FINDINGS AND AWARD: Means the finding or decision of an administrative law judge or the commission as to the amount of compensation or benefit due an injured employee or the dependents of a deceased employee.
CO-EMPLOYEE: Means every person employed by an injured employee's employer.
COMPENSATION: Means the money and benefits provided by workers' comp insurance carrier.
DATE OF INJURY (DOI): The date of injury refers to the date of your accident. If your injury is a gradual injury, than the date of injury is harder to pinpoint and is often assigned to the day that you became aware of the workplace injury. For more information on gradual injuries, see our post: http://www.fendonlaw.net/Legal-Blog/2016/July/Gradual-Injuries.aspx
INDEPENDENT MEDICAL EXAM (IME): This is a doctor's appointment that is scheduled by the insurance carrier. The independent medical examiner assesses your condition and determines what treatment they think is necessary. Frequently these exams result in the closure of your claim. These examinations are mandatory and you can be charged for missing an appointment. For more information please check out our blog post: http://www.fendonlaw.net/Legal-Blog/2015/November/What-is-an-Independent-Medical-Examination-.aspx and
INDUSTRIAL COMMISSION OF ARIZONA OR "THE COMMISSION" (ICA): Means the Industrial Commission of Arizona which is the administrative body (court) that is in charge of worker's compensation in Arizona.
INSURANCE CARRIER: Means the state run "special fund" and every insurance carrier authorized by the director of insurance to write workers' compensation or occupational disease compensation insurance in the state of Arizona. These are the people who are paying your compensation. The insurance carrier works for your employer.
INTERESTED PARTY: Means the employer, the employee, or if the employee is deceased, the employee's estate, the surviving spouse or dependents, the commission, the insurance carrier or their representative.
LABOR MARKET CONSULTANT (LMC): A labor market consultant can be hired by you or the insurance carrier. Their job is to determine whether or not they believe you have a loss of earning capacity. The look at your permanent work restrictions, your age, your job history, and your training and compare it to the job market to see what jobs you qualify for and how much money you can make going forward.
LIGHT DUTY STATUS: Means a doctor believes that you are able to return to work with some restrictions. This does not necessarily mean that a doctor believes you can returned to your date of injury job. This is the same as modified duty.
LOSS OF EARNING CAPACITY AWARD (LEC): Once you are no longer improving and your condition has plateaued, a doctor will determine if you have permanent work restrictions. If your injury is not to a scheduled body part and your injury unscheduled, the Industrial Commission of Arizona will decide how much money they estimate you will be able to make given your work restrictions, age, job history, education, and the current job market. If there is a difference between your average monthly wage before the injury and how much they estimate you can make, you have a loss of earning capacity and may be eligible for a lifetime monthly award.
MAXIMUM MEDICAL IMPROVEMENT (MMI): This is the same as permanent and stationary. When a doctor feels that you are no longer improving, they determine that you have reached your maximum medical improvement. This means there is no more treatment that can be offered to you that is designed to improve your condition. This signals the closure of your claim. Please see our post on Maximum Medical Improvement for more information: http://www.fendonlaw.net/Legal-Blog/2014/October/What-Does-Maximum-Medical-Improvement-Mean-.aspx
MODIFIED DUTY STATUS: Means a doctor believes that you are able to return to work with some restrictions. This does not necessarily mean that a doctor believes you can returned to your date of injury job. This is the same as light duty.
MONTHLY STATUS REPORT (MSR): These are reports that you fill out in order to receive your temporary partial disability benefits. It is a report of how much money you made and/or what jobs you have applied to.
NO WORK STATUS: Means a doctor does not believe that you are capable of performing any type of work.
ORDER: Means and includes any rule, determination or decision other than an award or a directive by the commission or an administrative law judge that has to do with whether or not you can get compensation benefits, or to the amount compensation you can get, and any procedural ruling related to your claim.
PERMANENT IMPAIRMENT AND PERMANENT IMPARIMENT RATING: This is determined by a doctor and is based on the 6th Edition American Medical Association Guidelines.
PERMANENT AND STATIONARY (P&S): This is the same as reaching your maximum medical improvement. When a doctor feels that you are no longer improving, they deem you permanent and stationary. This means there is no more treatment that can be offered to you that is designed to improve your condition. This signals the closure of your claim.
SCHEDULED AWARD: A scheduled awards is a monthly cash entitlement for a set period of time that you get after you are permanent and stationary. The amount awarded is based on your permanent impairment rating and the value determined by the State law. There is literally a list of body parts that says how any months of payment they are worth. These body parts include, finger, arm, leg, toe, wrist, ankle, etc. For more information see our post on scheduled injuries: http://www.fendonlaw.net/Legal-Blog/2016/August/What-Are-My-Body-Parts-Worth-Scheduled-Injuries.aspx
SUPPORTIVE MEDICAL CARE: Means medical care that is designed to help you maintain your condition. For example, medication and physical therapy can be supportive care.
TEMPORARY TOTAL DISABILITY COMPENSTAION (TTD): If a doctor place you on a no work status, then temporary total disability compensation is paid. It is paid at a rate of 66 and 2/3 of your average monthly wage. TTD is paid once every 14 day period.
TEMPORARY PARTIAL DISABILITY COMPENSATION (TPD): If a doctor places claimant on a light duty or modified duty status then temporary compensation is paid once every 30 day period. This is paid at a rate of 66 and 2/3 of the difference between your average monthly wage and any earnings you had from a job during that period. While you are on TPD, if you have not returned to your date of injury job, you are required to look for work within your restrictions and keep a record of your work searches.
UNSCHEDULED AWARD: This is an award for any body part that is not listed in the list of scheduled body parts. Typically these are back, shoulder, hip, and head injuries. Compensation for these injuries are based on your loss of earning capacity. Please see our post on unscheduled injuries: http://www.fendonlaw.net/Legal-Blog/2011/July/Permanent-compensation-unscheduled-.aspx
WORK RESTRICTION: These are restrictions given by a doctor indicating what work you are prohibited from doing. For example, no lifting more than 20 pounds, no sitting for more than 30 minutes, no bending, etc.