No matter what causes you to file a workers’ compensation claim, you know that you’ll need the assistance of an experienced lawyer to ensure a successful outcome. But when you visit with your attorney, you may have a harder time following along in your discussions.
Rather than remain confused during the proceedings, you should familiarize yourself with many of the common terms you hear. In the blog below, we list various legal terms and phrases you may hear as you continue to meet with a workers’ compensation lawyer. Accepted Claim
A claim that an insurance company covers under workers’ compensation. Even if a claim has been accepted (or admitted), other factors may delay benefits and compensation.
Americans With Disabilities Act
This federal law states that employers cannot discriminate against individuals based on any type of disability. If you were injured while at work, this act protects your right to work for other employers in the future.
Also called “reconsideration.” If your original claim is denied, you have the right to appeal the judge’s decision. A group of commissioners (the appeals board) will review your case and reconsider the judge’s decision.
Typically the person who was injured and has filed a workers’ compensation claim. In some cases, a family member may be considered the applicant if he or she files a claim on behalf of the injured individual. Also referred to as “claimant.”
Application for Adjudication of Claim
More simply called an application. The applicant fills out this form to when he or she files a claim with the Workers’ Compensation Appeals Board in his or her state of residence.
A process that determines how much permanent disability was caused by a work-related injury or incident.
Insurance companies send this required form to a claimant. The notice details the benefits the claimant is eligible to receive.
A staff member that works for the insurance company and manages all aspects of a claim. Claims adjusters can also work for third parties associated with the claim.
A judge-ordered, lump sum payment of compensation for permanent disability. The judge may order the payment to be made in parts or in full.
An injury caused by continuous exposure or repeated incidents in the workplace. For example, moving your hands in the same motion on a daily basis can cause a cumulative injury to your wrist.
Insurance companies send this type of letter to a claimant, explaining why payments or benefits have been delayed. The letter also outlines additional steps a claimant must take (and information he or she must provide) before payments can be sent out or before benefits can be awarded.
If an applicant files a workers’ compensation claim and then gets fired for doing so, the applicant can file this petition (also called a “retaliation claim”) with the Labor Commissioner.
A disagreement between the claimant and the insurance company regarding the claimant’s benefits, payments, and other related compensation.
An applicant’s continued right to receive medical treatment in the future for work-related injuries.
An estimate of how much normal use an applicant loses in a specific body part. This percentage is determined by guidelines the American Medical Association’s set. Medical professionals will also use this estimate to calculate an applicant’s permanent disability rating.
Medical professionals compile these reports to settle disputes in workers’ compensation claims. Information in these reports includes any details relating to a claimant’s injury and medical condition.
Observations, test results, and measurements that a qualified medical expert says contribute to a claimant’s permanent disability.
The Occupational Safety and Health Administration. This organization inspects work environments and establishes safety protocols to protect employees from injury and harm.
Permanent Disability Rating
This rating refers to any remaining disability a claimant has after he or she has completed all necessary treatment and therapy for an injury.
An injury a claimant sustains from one specific event in the workplace. For example, if a claimant slips and falls in a puddle of water and injures his or her leg, the resulting injury would be referred to as a specific injury in the claim.
Any pain, suffering, and other related factors an applicant experiences as a result of an injury and that contribute to permanent disability. Typically, a medical professional will report these findings in the medical-legal report. However, objective factors have more weight in a workers’ compensation claim than subjective factors do.
The process insurance companies use to decide if they will authorize treatment and pay for the associated expenses.
The restrictions a doctor sets to prevent a claimant from further injuring himself or herself while at work.
Now that you have a better understanding of what these common workers’ compensation terms mean, you can approach your claim with confidence. With this glossary as an aid, you can more easily understand the legalities that surround your specific case.
As you meet with your workers’ compensation attorney, keep these terms in mind. This list only mentions a few terms, so if you hear a phrase that you don’t quite understand, ask your lawyer to explain it to you. He or she has the responsibility to ensure that you understand every aspect of your case.
For more information about how a lawyer can help your specific situation, read through the rest of our blog.