If you've never been through the workers' compensation system before, the terminology might seem confusing and overwhelming. MMI? IME? TTD? Workers' comp lingo is filled with so many acronyms it can be as confusing as reading through medical records. This article explains some of the most common abbreviations and what they mean, so you can understand what's going on with your claim.
Denied workers' compensation claims are heard and decided by administrative law judges with the state workers' compensation agency.
The average weekly wage is used to determine the amount of benefits a worker is entitled to in most states. A worker's average weekly wage is usually calculated by taking his or her earnings in the last year and dividing by 52. Workers' comp benefits are typically a percentage of the AWW. For example, in many states, temporary disability payments are two-thirds of the worker's AWW.
A compromise and release is a type of settlement agreement entered into by an injured worker, the worker's employer, and the employer's insurance company. In a C&R, the worker agrees to close the workers' comp claim for good, in exchange for a lump sum payment. In most states, C&Rs are the most common type of settlement. (To learn more, see Getting a Fair Amount From Your Workers' Comp Settlement.)
In most states, when a worker is injured, the employer (or sometimes its insurance company) is required to file a first report of injury with the state workers' compensation agency. In some states, this is the official start to a workers' compensation claim. In other states, the worker also needs to file a claim form with the employer and the state agency.
A functional capacity evaluation is used to assess whether an employee is able to perform certain physical tasks related to their job duties, such as holding, reaching, bending, standing, and more.
An independent medication examination is used to evaluate a worker's condition, especially with regard to whether the employee has suffered a permanent impairment. IMEs are usually ordered by the insurance company and performed by a doctor of its choosing. The insurance company then uses the IME report to dispute the opinions of the worker's treating doctor, in order to deny or reduce benefits. (For more information, see What is an Independent Medical Examination and How Will It Affect My Workers' Compensation Case?)
Once a worker has reached maximum medical improvement (see below), the treating doctor will examine the worker and decide whether he or she has a permanent impairment. If the worker does, the doctor assigns an impairment rating—usually stated as a percentage—to the permanent disability. For example, a doctor may give a worker a 50% impairment rating as to the right arm.
In many states, employers are free to set up managed care organizations that coordinate treatment for workers' compensation injuries. If your employer has an MCO, you may need to treat with a doctor in the MCO's network.
A doctor finds that a worker has reached maximum medical improvement when his or her condition has improved as much as it's going to with treatment. At this point, the worker is examined by the treating doctor to determine whether he or she is permanently impaired.
A worker who has a permanent impairment, but who can still work in some capacity, has a permanent partial disability. In some states, a PPD award is granted when the worker has suffered a loss of use of a body part, even if the worker is still able to earn the same wages. In other states, the worker must also have suffered a loss of wages in order to receive a PPD award. (See How to Get Permanent Partial Disability Benefits Through Workers' Comp for more information.)
Only very serious injuries—such as the loss of both eyes, hands, feet, arms, or legs (or a combination of two of any of these body parts)—that leave the employee unable to work in any capacity will qualify as permanent and total disabilities.
A repetitive stress injury is one that develops over time when a worker is required to repeat the same motions as part of his or her job duties. For example, a grocery store clerk who makes the same scanning motions dozens of times per day may develop carpal tunnel syndrome.
The statute of limitations is the deadline for filing a workers' compensation claim or for filing an appeal of a denied claim.
An employee who is able to perform light duty or other modified work while recovering from a work injury (before reaching maximum medical improvement) is considered to have a temporary partial disability.
An employee who is unable to work while recovering from a work injury (before reaching maximum medical improvement) is considered to have a temporary total disability.