If you’ve never filed a workers compensation claim before — and especially if you’ve never been involved in any kind of lawsuit before — you might be confused by some of the terminology used. The following terms and abbreviations below are just some of the most common phrases used in workers compensation claims. If you have questions about any of the definitions below, or if you need more information about any related topics, be sure to contact a local workers compensation lawyer Milwaukee, WI trusts for legal counsel.
Average weekly income: When an insurance company provides workers compensation benefits for lost wages or for disability compensation, they usually determine the amount of money paid out by looking at the individual’s average weekly earnings. Insurers typically offer no more than 66.6% of the individual’s average weekly income.
First report of injury (FROI): After an employee is injured, they must report the incident to their employer, who then files a first report of injury with the state’s workers compensation board. This is often considered the “beginning” of the claims process.
Independent medical exam (IME): This examination is usually required by the insurance company after a worker files for workers comp benefits, and the purpose is to assess the individual’s injuries. It’s common for the insurer to choose which doctor or healthcare organization will perform the IME. The individual can seek care from another doctor of their choosing, but the insurer will likely provide or deny benefits based on the results of the IME.
Managed care organization: Many larger businesses are allowed to work with managed care organizations to coordinate medical care if/when an employee is injured on the job. An injured employee may be required to seek medical care through this organization in order to receive workers compensation benefits.
Permanent partial disability (PPD): PPD is when an individual is permanently injured but is still able to work in some way. If the individual suffers wage loss because they can only perform tasks in lower-paying jobs, workers comp may provide compensation.
Permanent total disability (PTD): With PTD, the individual is permanently injured and will likely never be able to work again.
Pre-existing condition: Workers comp isn’t just intended for individuals with brand new injuries. If an individual with a pre-existing condition is injured, and if this injury directly worsens the condition, they may be able to claim compensation.
Statute of limitations: This is a legal term that appears often in discussions about personal injuries. It refers to the amount of time that can pass between an accident (or the discovery date of the injury/illness) and when that person files a claim for compensation. In workers comp cases, there may also be a statute of limitations dictating how much time can pass if an individual’s claim is denied and they wish to file an appeal.
Temporary partial disability (TPD): TPD refers to an injury that will eventually heal, and while it is healing, the individual can perform some job duties.
Temporary total disability (TTD): With a temporary total disability, the individual cannot return to work for some time, but will eventually fully recover and be able to work again.
Thank you to our friends and contributors at Hickey & Turim for their insight into workers compensation terms.
