Is this your first time filing a claim for workers’ compensation? Are you finding all of the new terminology in your claim documents confusing and overwhelming? At The Law Office of George P. Escobedo & Associates, PLLC, we understand how frustrating it can be to decode all of these various acronyms as you read through medical records. We want to make filing your workers’ compensation claim simple, which is why we list 13 common abbreviations you need to know if you want to collect the compensation you deserve.
The administrative law judge (ALJ) with the state workers’ compensation agency hears workers’ compensation claims that have been denied.
In order to determine the amount of benefits you are entitled to, you will have to determine your average weekly wage (AWW). To calculate your average weekly wage, take your earning from the last year and divide by 52. Your benefits will be a certain percentage of the AWW. For example, disability payments are usually two-thirds of your AWW.
This stands for compromise and release (C&R), which is a type of settlement that the injured worker, the worker’s employer, and the employer’s insurance company agree on. Under a compromise and release settlement, the injured worker agrees to completely close their claim in exchange for a lump sum payment. Most workers choose this type of settlement.
Most states require employers to file a first report of injury (FROI) with the state workers’ compensation agency when one of their employees gets seriously hurt at work. Other states also require the injured worker to file a claim with both the employer and the state agency.
The functional capacity evaluation (FCE) will assess your ability to perform certain physical tasks that you need to be able to do your job. This can include testing your ability to hold, reach, bend, and stand.
Insurance companies usually order injured workers to undergo an independent medical examination (IME). This exam is performed by a doctor chosen by the insurer. The IME report can be used to dispute the worker’s treating doctor in order to limit or deny compensation.
When you reach maximum medical improvement, your doctor will assess you to determine if you have a permanent impairment. If the doctor finds an impairment, they will assign you an impairment rating (IR).
Some states allow employers to establish managed care organizations. MCOs coordinate treatment for workers’ compensation injuries. If you work for a company with an MCO, you might have to be treated by a doctor in the MCO’s network.
Maximum medical improvement (MMI) occurs when your condition improves as much as it’s going to with treatment. Once you reach this point, your doctor will assess you to see if you are permanently impaired.
You can still receive benefits if you have a permanent impairment but you still have the capacity to work. This is called permanent partial disability (PPD).
In order to qualify for permanent and total disability benefits (PTD), you must suffer a catastrophic injury that leaves you unable to work in any capacity. Losing your hands, arms, feet, legs, or eyes in a work-related accident would make a worker eligible for PTD benefits.
There are deadlines for filing your workers’ compensation claim or appealing a claim that has been denied. These delaines are called the statute of limitations (SOL).
If you can perform light duty or other modified work while you are recovering from your injury, you have a temporary partial disability.
If you can’t work in any capacity while you are recovering from your injury, you have a temporary total disability.
Do you have more questions about filing your workers’ compensation claim? Call (210) 807-3178 to schedule a free case consultation with a San Antonio workers’ comp attorney. We’re available 24/7.