Mouprise.com

Workers Compensation Terms to Know

Claim accepted: A claim where the insurance company accepts or agrees that your injury or illness will be covered by workers’ compensation.

Medical only claim: A claim where the insurance company or employer agrees that you have been injured, however they believe you are still able to work and as such will only pay for medical treatment.

Claim denied: A claim where the insurance company or employer does not accept or believe they have a responsibility to provide compensation for your injuries.

Average weekly salary: The average weekly wage of the injured employee before the injury. To determine the average weekly wage, you must look at the injured person’s 52 weeks of wages prior to the date of the accident. You usually add the annual salary and then divide it by 52 weeks. If there is no 52 weeks, most of the time the insurance company or employer simply uses the average of those weeks the injured employee worked prior to the date of injury. (This may or may not be correct, as it depends on what is fair and reasonable. For example: If you have only worked for the employer for less than three months, this is most likely an accurate picture of what your ability is to earn salary). would be for that position).

Compensation rate: The compensation rate is two-thirds of the injured employee’s average weekly wage.

Temporary Total Disability: Weekly disability compensation provided to the injured employee for his or her inability to work. Disability payments are provided at the employee’s compensation rate.

Temporary Partial Disability: Weekly disability compensation provided to the injured employee for their reduction in their average weekly wages due to the compensable injury. Disability payments are two-thirds of the difference between the injured person’s wages before the injury and wages after the date of injury.

Qualification of Partial Permanent Disability: The percentage amount assigned to a body part used to determine the number of weeks the injured person is entitled to as compensation for their injury. The partial permanent disability rating is assigned by the treating physician.

Maximum Medical Improvement (MMI): Once the injured employee’s condition is unlikely to change or improve with or without additional medical treatment, an “MMI” is determined. Maximum medical improvement is determined by the licensed treating physician. Generally, when the injured employee reaches maximum medical improvement, he or she is discharged from medical care.

Light or modified work: Temporary employment offered by the employer to the injured employee while on restrictive duty by the treating physician.

Suitable Employment: Once the employee arrives at MMI, the injured employee is required by law to return to suitable employment. Suitable employment is permanent employment available in the competitive marketplace, within the employee’s physical, educational, and vocational capabilities. The job must also be comparable in wages to the injured person’s position prior to the injury.

Vocational Rehabilitation: If you are permanently unable to perform your regular job and your employer does not offer you another suitable job, you will qualify for this benefit. It may include job placement advice, retraining and a maintenance allowance for vocational rehabilitation.