Workers’ compensation

Terms to Know Related to Workers Compensation

Injury: Harm to a worker subject to treatment and/or compensable under workers’ compensation. Any wrong, or damages done to another, either done to his/her person, rights, reputation, or property.

Workers’ Compensation: An insurance program that provides medical benefits and replacement of lost wages for persons suffering from injury or illness that is caused by or occurred in the workplace. It is an insurance system for industrial and work injury, regulated primarily among the separate states, but regulated in certain specified occupations by the federal government. 

Workers Compensation Commission: One of many terms identifying the state public body which administers the workers’ compensation laws, holds hearings on contested cases, promotes industrial safety, rehabilitation, etc. It is often located within the state labor department. The national organization is the International Association of Industrial Accident Boards and Commissions. 

First Report of Injury: Formal document completed by employer on report of a work-related injury or condition that begins process or workers comp claim.

Functional Capacity Evaluation (FEC): A systematic process of assessing an individual’s physical capacities and functional abilities. The FCE matches human performance levels to the demands of a specific job or work activity or occupation. It establishes the physical level of work an individual can perform. The FCE is useful in determining job placement, job accommodation, or return to work after injury or illness. FCEs can provide objective information regarding functional work ability in the determination of occupational disability status. 

Functional Job Analysis: Defines the job requirements including both essential and nonessential duties. 

Independent Medical Evaluation (IME): Evaluation completed by a medical practitioner selected by the Workers Compensation payer to confirm, rebut, or supplement medical findings offered by the injured worker’s chosen physician or other provider. 

Total Disability: An illness or injury that prevents an insured person from continuously performing every duty pertaining to his/her occupation or engaging in any other type of work.

Partial Disability: The result of an illness or injury which prevents an insured from performing one or more of the functions of his/her regular job. 

Maximum Medical Improvement (MMI), Maximum Medical Recovery (MMR): The injured worker has recovered from injuries to a level that a physician states further treatment will not substantively change the medical outcome. This does not necessarily mean that the injured worker is back to baseline. 

Overview of Workers Compensation for the Case Manager

Workers’ compensation laws protect employees who are injured or disabled on the job and are designed to ensure that they are provided with fixed monetary awards eliminating the need for litigation. Workers covered by workers comp can not sue their employer for work related injuries. Benefits are awarded to the worker regardless of who was at fault for the accident. The employer is 100% responsible for paying for the insurance and is also responsible for filing the First Report of Injury. In addition to injured and disabled workers, workers compensation laws also provide benefits for dependents of workers who are killed because of work related accidents or illnesses. 

Workers Comp regulations very from state to state, and the state mandates take precedence over the financial status or will of the employer. Federal statutes are limited to federal employees or those workers employed in some significant aspect of interstate commerce.

Federal Workers Compensation Programs

  • Federal Employment Compensation Act provides workers’ compensation for non-military, federal employees.
  • Federal Employment Liability Act (FELA) ensures that railroads engaged in interstate commerce are liable for injuries to their employees if they have been negligent.
  • Merchant Marine Act (the Jones Act) provides seamen with the same protection from employer negligence as FELA provides for railroad workers.
  • Longshore and Harbor Workers’ Compensation Act (LHWCA) provides workers’ compensation to specified employees of private maritime employers.
  • Black Lung Benefits Act provides compensation for miners suffering from “black lung”. The Act requires liable mine operators to pay disability payments and establishes a fund that provides disability payments to miners where the mine operator is unknown or unable to pay.

Workers’ compensation pays for:

  • medical care for work related injuries beginning immediately after the injury occurs
  • temporary disability benefits after a waiting period of three to seven days
  • permanent partial and permanent total disability benefits to workers who have lasting consequences of disabilities caused on the job
  • rehabilitation and training benefits for those unable to return to pre-injury careers
  • benefits to survivors of workers who die of work-related causes