A WORKERS’ COMPENSATION DICTIONARY
.512 Appeal: Appeal based on R.C. 4123.512. That section of the law provides that a party to a workers’ compensation claim may file an appeal from a decision of the Industrial Commission, other than a decision involving the extent of a claimant’s disability, in the common pleas court of the county in which the injury occurred or in which the occupational disease was contracted.
A
Accident: Unexpected or unusual incident. There does not need to be a “slip, twist or fall” for there to be an injury under the workers’ compensation laws.
Active Claim: A “medical-only” claim is active for six years from date of last payment of medical benefits. A “lost-time” claim is active for ten years from date of last payment of compensation or medical benefits.
Actuary: Professional who calculates insurance risks; frequently used to refer to an employer’s non-legal representative in workers’ compensation claims.
Additional Award (“VSSR”): An award of penalty compensation paid to a claimant when an employer has violated a specific safety requirement and the violation caused an injury.
Adjudicating Committee: Bureau of Workers’ Compensation committee that hears employer appeals arising from auditing, rating and actuarial matters.
Adjudication: Determination of the rights to compensation or benefits.
Administrator/CEO of Workers’ Compensation: The person selected by the Workers’ Compensation Board to administer the Bureau of Workers’ Compensation.
Americans with Disabilities Act (A.D.A.): Places affirmative obligations on employers to reasonably accommodate qualified disabled workers. The provisions of the Act applies to employers with 15 or more employees.
Ankylosis: A medical term describing the total stiffness of a joint. If a joint is ankylosed, a person may be entitled to the same benefits as for an amputation.
Appeal: Formal notification of a party’s dissatisfaction with and challenge to a decision of district hearing officer, staff hearing officer(s) or Industrial Commission. A “Notice of Appeal” is filed to take an issue to the next level of consideration.
Arising Out of Employment: A causal connection to the employment; a direct relationship to the employment. In order for there to be a compensable injury, the injury must result from a hazard of employment: a compensable injury is incidental to work, not coincidental.
Atrophy: The wasting of a muscle through disuse.
Attending Physician: The same as Physician of Record; a claimant has a right to change attending physicians as he wishes.
Average Weekly Wage (AWW): Average weekly wage for the 52 weeks prior to injury or occupational disease; may be adjusted where unusual circumstances produce an unfair, low AWW.
B
Blankenship: The Ohio Supreme Court’s 1982 decision in Blankenship v. Cincinnati Milicron Chemicals, in which the Court held that an employer could be held directly liable to an employee for damages where an employee was injured through the employer’s commission of an intentional tort.
Bureau of Workers’ Compensation (B.W.C., Bureau): The agency charged with the administration of the workers’ compensation laws. C-92: The form used to claim entitlement to partial disability benefits. Applications for an increase in such benefits are made by filing a Form C-92A.
C
Catastrophe: A single incident producing two deaths or two permanent total disability claims or a combination of the two.
Certification: Statement on a claim application which, when signed by an employer, verifies the facts stated and consents to the allowance of the claim and the payment of compensation without a hearing.
Change of Occupation Benefits: Compensation for claimants with certain respiratory diseases who must be removed from a particular employment environment to reduce injurious exposure.
Chiropractic: The theory of chiropractic healing is based on the belief that disabilities and illnesses may be attributed to a dysfunction of the nervous system. Chiropractic adjustments to the spine and other body structures are the form of treatment most often used.
Chiropractor: A chiropractic doctor is designated the initials “D.C.” following his name. Chiropractors are licensed by the State of Ohio, but may not prescribe medication or perform invasive procedures.
Claim File: Agency file which contains the record of pertinent information and record of payments.
Claimant: Employee who is injured, or an employee who has contracted an occupational disease, in the course of employment; the person pursuing workers’ compensation benefits.
Classification: Category of industries or occupations according to degree of hazard. Compensation: Monies paid to an injured worker who has been off work more than seven days due to a work-related injury or occupational disease, or who has received a permanent partial disability award.
Continuing Jurisdiction: Authority of Bureau or I.C. to grant further compensation within six years of payment of medical benefits in “medical-only” claim and within ten years of last payment of compensation or medical benefits in “lost-time” claims.
Course of Employment: Engaged in activities on behalf of the employer and consistent with contract of hire.
D
Deny: When an employer determines that a claimed injury or occupational disease is not work-related and does not voluntarily accept the claim as valid, it denies the claim.
Disability: Impairment which affects a claimant’s ability to work.
Disabled Workers’ Relief Fund (DWRF): Provides a supplement to an injured worker who is receiving permanent and total disability compensation if the injured worker’s compensation rate, when combined with Social Security, is below a certain minimum rate.
District Hearing Officer (D.H.O.): Hearing officer at district hearing; presides at the first level of the Industrial Commission hearing process.
Division of Safety and Hygiene: A part of the Bureau that conducts examinations of work places, often in connection with occupational disease claims and in connection with violations of specific safety requirements. The Division will also inspect workplaces at the request of employers to determine hazards.
D.O.B.: Date of birth.
D.O.D.: Date of disability.
D.O.I.: Date of injury.
E
Election: Choice made by a claimant to receive a percentage award of permanent partial disability in lump sum or to receive the award on an impairment of earning capacity basis. (Applies only to claims with D.O.I. prior to August 22, 1986.
Employer: Every person, firm, corporation, agent, manager, representative, or other person having control over or custody of any employment, place of employment or employee.
Employer of Record: The employer to which the workers’ compensation claim is charged.
Employer Risk Number: A unique number assigned by the Bureau of Workers’ Compensation identifying individual employers.
Employment: Any trade, occupation, or process of manufacturing.
Exclusivity or Exclusive Remedy: Under the Ohio system, when an employee was injured on the job an employer was to be liable only for workers’ compensation benefits if he complied with the workers’ compensation laws. Since 1982, there has been a limited form of liability for employers who commit what are called “intentional torts.”
F
Fee Bill: Written request for payment for services rendered by a health care provider.
Filing a Claim: Notification to the self-insuring employer or to the Bureau of Workers’ Compensation that an alleged work-related injury or occupational disease has occurred and that an injured worker seeks compensation and/or benefits therefor.
Filing with the Bureau: Submitting information concerning a workers’ compensation claim to the Bureau of Workers’ Compensation.
Full Weekly Wage (FWW): Comparison of a claimant’s last full week worked prior to D.O.I. and the average of the claimant’s last six weeks worked prior to D.O.I. The higher of the two is the full weekly wage and is generally the basis for computing the rate to be paid for the first twelve weeks of compensation and, in some cases, for wage loss compensation.
G
Going and Coming Rule: An employee with a fixed or regular place of employment is not entitled to workers’ compensation benefits when injured while in route to or from his job.
H
Handicapped: For workers’ compensation purposes -- disabled because of one of the listed conditions in R.C. 4123.343.
Handicapped Reimbursement: Provision of the workers’ compensation law that is a cost relief program to encourage employers to hire and retain handicapped employees. If an injury is caused by, or the disability of a claimant is increased by, one of the enumerated conditions, an employer
may be eligible for relief from all or a portion of the costs of the claim.
Hearing: A proceeding for adjudicating a disputed issue in a claim.
I
IC-5: The former code of safety requirements applicable to all workshops and factories. The specific safety requirements are now contained in Ohio Administrative Code 4123-1-1 through 4123-1-17.
Independent Medical Examination (I.M.E.): Evaluation by a neutral examiner to provide clarification of the conditions to be allowed in a claim, to determine the extent of a claimant’s disability, or to resolve any other issue in a claim requiring medical expertise. Also, some people use this term to describe an examination undertaken at the request of the employer.
Impairment of Earning Capacity: A lessening of ability to earn as a result of injury or occupational disease.
In the Course of: The requirement that in order for an injury or an occupational disease to be compensable, it must have been sustained or contracted while performing duties related to employment.
Incentive Payment: Payment made by Rehabilitation Division to an employer as an offset when a claimant’s disability and the requirements of the job will result in a temporary and significant decrease in productivity.
Independent Specialist: A doctor chosen by the Industrial Commission to examine a claimant. Most frequently an independent specialist’s examination is undertaken when there is a conflict in the medical evidence in the claim file regarding an issue.
Industrial Commission (I.C.): Adjudicating body of the workers’ compensation system; oversees and interprets the laws concerning workers’ compensation and is responsible for the administrative adjudication of disputed workers’ compensation matters.
Injury: A harm, injurious condition or disability caused by a work-related activity. There need not be a sudden accidental occurrence for there to be an injury.
L
L.P.N.: Licensed Practical Nurse.
L.D.W.: Last day worked.
Living Maintenance (L.M.): Payment to a claimant who is participating in an approved rehabilitation plan.
Loss of Member: Traumatic or surgical amputation of body part specified in R.C. 4123.57. A part rendered useless by ankylosis is also considered “lost.”
Lost-Time Claim: Claim involving more than seven days of time lost from work due to injury or occupational disease.
Lump-Sum Advancement: Commutation of an existing and unpaid award to one or more lump-sum payments. A claimant may receive an advancement for attorney’s fees or for extraordinary purchases.
Lump-Sum Settlement: Final disposition of a claim or part thereof, by agreement of the parties and order of staff hearing officers, in return for a lump-sum payment.
M
Mandamus: A court proceeding that may be instituted in the Common Pleas Court of Franklin County, the Court of Appeals for Franklin County, or the Supreme Court of Ohio in which a party may challenge a final decision of the Industrial Commission, other than decisions which may be appealed under R.C. 4123.512.
Manual Numbers: Numbers used to identify job classifications or categories which are grouped by similar hazard and which are used to determine premium or contribution rates for State Fund Employers.
Maximum Medical Improvement (M.M.I.): A treatment plateau (whether static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures. A claimant may need supportive treatment to maintain this level of function.
MMPI: Minnesota Multiphasic Personality Inventory; a psychological test of personal and social adjustment.
Mechanotherapist: A person who uses mechanical apparatuses for therapeutic exercises. Medical Provider: Licensed, qualified health care professional who provides treatment or services to a claimant for a work-related injury or occupational disease.
Medical Section: The Industrial Commission and the Bureau each have a Medical Section. Conducts examinations of claimants for percentage of permanent partial impairment, performs file reviews, renders advisory medical evaluations, etc.
Medical-Only: Claim involving seven days or less of lost time in which medical expenses are payable.
Modalities: Forms of treatment, frequently used in conjunction with chiropractic adjustment or manipulation or physical therapy such as heat, electricity, cold packs, etc.
Motion: Form (C-86) filed with the Bureau or I.C. to obtain a hearing concerning a particular issue or to request certain action not specified to be made by the use of other forms.
N
Narrative Medical Report: Detailed report from a doctor stating diagnosis, prognosis, course of treatment, etc., concerning the injury or occupational disease.
Net Take Home Weekly Wage: Injured worker’s total remuneration for first four of last five calendar quarters immediately preceding the first day of employee’s entitlement to compensation, divided by the number of weeks the employee was paid during those four quarters, less income
taxes deducted.
Non-Complying Employer: An employer who is subject to the workers’ compensation law but who has failed to pay its premium.
O
Occupational Disease (O.D.): Any of the diseases described in R.C. 4123.68 and in R.C. 4123.01(F) which have been contracted by the employee in the course of employment.
Ohio Bureau of Employment Services (OBES): The agency charged with administering Ohio’s unemployment compensation insurance system. A claimant may not receive both total disability compensation and unemployment compensation. The statutes provide for repayment when a claimant receives unemployment compensation and subsequently is determined to be entitled to workers’ compensation benefits.
Ohio Revised Code (O.R.C., R.C.): The statutory law of Ohio.
On the Record (Submitted on the Record): Phrase used by a representative when an appeal is taken in order to gain time to obtain additional evidence or to keep an issue alive. An appeal may be “submitted on the record.” In effect, the party “submitting the claim” concedes that there is nothing new and the previous decision should be affirmed.
Order (Record of Proceedings): Document recording the decisions of the Bureau and I.C. in which formal actions are reduced to writing and become official.
Orthotic Device: An appliance or apparatus used to support, align, prevent or correct deformities or to improve the function of movable parts of the body.
OSHA: The Occupational Safety and Health Act of 1970 or the Occupational Safety and Health Administration.
Osteopath: A doctor of osteopathic medicine, designated by the initials “D.O.” following the doctor’s name. Doctors of osteopathy essentially receive the same training that medical doctors (M.D.) receive. Post-graduate training may vary. Doctors of osteopathy are licensed by the State of Ohio and may perform the same services as medical doctors such as prescribing medication, performing invasive procedures, etc.
Osteopathy: Originally, osteopathic medicine principally treated the spine and musculature with manipulation, based on a theory that the body is capable of remedying disease if it is in its normal structural relation and there is adequate nutrition. Now, osteopathic physicians and medical doctors may and do perform similar services.
P
Pain and Stress Management: Rehabilitation services providing individualized, comprehensive and group therapeutic treatment and education to improve claimant’s pain management abilities, physical capacities and work tolerance.
Paragraph A: The “temporary partial” award. Only applicable to claims arising prior to August 22, 1986. “Paragraph A” benefits are partial disability benefits paid on an impairment in earning capacity basis.
Paragraph B: “Old” R.C. 4123.57(B). The “permanent partial” award. This type of partial disability compensation is paid in lump sum under a formula by which each percentage point of compensation awarded is equal to two weeks of disability benefits at the rate in effect for the year of the injury. Since 1986, lump sum benefits are provided at R.C. 4123.57(A).
Paragraph C Loss: “Old” R.C. 4123.57(C) provided for compensating scheduled losses such as those suffered through amputation; since 1986, scheduled loss benefits are provided at R.C. 4123.57(B).
Permanency: One of the criteria for the termination of temporary total disability compensation. A “permanent” disability is defined as a condition which will, with reasonable probability, continue for an indefinite period of time without any present indication of recovery therefrom.
Permanent Partial (P.P.): An impairment from a work-related injury or occupational disease that has become permanent but is only partially disabling to the claimant. An injured worker may file an application for such an award forty weeks after the termination of temporary total disability compensation or forty weeks after D.O.I.
Permanent Total: Impairment from a work-related injury or occupational disease that has become permanent and prevents the claimant from performing any sustained remunerative employment. A claimant is automatically entitled to permanent and total disability compensation when he suffers the loss of, or loss of use of, both hands, both feet, both legs, both eyes or any two thereof and is paid such compensation irrespective of whether the claimant returns to work.
Permanent and total disability benefits are paid for the claimant’s life.
Physiatrist: A physical medicine and rehabilitation specialist.
Physical Capacities Evaluation: Evaluation to determine a claimant’s current physical abilities.
Physician of Record: Injured worker’s physician recognized as the attending physician by the Bureau and/or employer for treatment of injury or occupational disease.
Prosthesis: A device used as a replacement for a missing body part.
R
R.N.: Registered Nurse.
Ramirez: A landmark case in which the Supreme Court held that an injured employee was entitled to temporary total disability compensation until he returned to work, his attending physician made a written statement that he was capable of returning to his former position of employment, or his disability became permanent.
Reactivation: Reinstatement of a claim in which compensation and benefits have not been paid recently. For many years, the Bureau of Workers’ Compensation provided a Form C-85-A, Application to Reactivate Claim. On the front side of the form is a description of the compensation or benefits requested; on the reverse side is a space for the attending physician to certify the claimant’s entitlement to the benefits or compensation requested. The form is no longer published but remains in circulation at this time.
Reconsideration: A form of appeal taken from an order regarding permanent partial disability compensation.
Recreational Waiver: An employee may waive his right to receive workers’ compensation benefits for an injury sustained during his participation in an employer-sponsored fitness or recreational activity. The waiver must be signed and filed prior to his engaging in the activity to be a valid waiver.
Rehabilitation: A structured program with the goal of returning the injured worker to employment.
Rehabilitation Division: Division of B.W.C. overseeing rehabilitation programs.
Reimbursement Agreement: An offset provision. Agreement signed by a claimant that monies received from employer’s wholly funded non-occupational insurance program will be reimbursed to the program from any workers’ compensation benefits determined to be due the employee.
Reserves: An approximation of the anticipated costs that will be charged over the life of a claim. A state fund contributing employer pays a premium for its workers’ compensation coverage. The premium is based on a percentage of the payroll. The percentage applied to the payroll is determined by the hazard of the business and the company’s experience in claims that have arisen in four of the last five calendar years. In determining the rate, the Bureau adds the
actual costs of the claims arising during that period with the reserves that have been set.
Risk: The insured employer.
Risk Number: The individual number assigned to each employer.
R.T.W.: Return to work.
S
Division of Safety and Hygiene: A part of the Bureau that conducts examinations of work places, often in connection with occupational disease claims and in connection with violations of specific safety requirements. The Division will also inspect workplaces at the request of employers to determine hazards.
Scheduled Loss: R.C. 4123.57 lists the number of weeks of compensation payable for the loss of a body member or part thereof.
Schell: This 1990 decision of the Supreme Court provided that an employee who sustains a mere aggravation, as opposed to a substantial aggravation, of a pre-existing condition is entitled to workers’ compensation benefits for the pre-existing condition.
Scope of Employment: A duty or action consistent with the contract of hire, is performed within the scope of employment.
Self-Insured Employer (S.I.): Employer who qualifies to pay compensation and benefits directly to employees in accordance with the law and rules of the I.C. and Bureau and is granted the privilege by the Administrator of the Bureau of Workers’ Compensation.
Self-Insured Review Panel: Advises the Administrator of Workers’ Compensation and the Bureau’s Self-Insured Employer Section, conducts hearings on matters referred to the Panel regarding self-insuring employers meeting standards for self-insuring status.
Self-Insuring Employer: See Self-Insured Employer.
Self-Insuring Employers Evaluation Board (SIEEB): Investigates and hears unresolved complaints or allegations of misconduct brought against self-insuring employers; investigates whether a self-insuring employer continues to meet performance standards.
Sickness and Accident Insurance: Insurance typically provided by an employer to cover the employee and dependents for non-industrial accident and illness. Such non-industrial insurance is often paid pending a claimant’s receipt of workers’ compensation benefits.
Special Hearing: Formal hearing on a disputed matter, with Notice to all parties.
Specific Safety Requirement: Standard established or promulgated by the Bureau of Workers’ Compensation to protect employees’ safety.
Staff Hearing Officers (S.H.O.): Hearing officers of the Industrial Commission who hear second-level appeals, reconsideration of permanent partial matters, handicapped reimbursement matters, violations of specific safety requirements, permanent total matters, and other matters delegated by the I.C.
State Fund Employer: An employer may not privately insure workers’ compensation obligations in Ohio. Employers may either contribute to the state insurance fund or self-insure if they are of requisite size and meet other criteria. Compensation and benefits in a claim filed against a State Fund Contributor are paid from the State Insurance Fund and the employer’s account is charged for the payment.
State Insurance Fund: The State Insurance Fund is a multi-billion dollar fund which guarantees the payment of workers’ compensation benefits to and on behalf of employees in the State of Ohio. All employers, unless they are granted the privilege of self-insurance, must secure workers’ compensation insurance by contributions to the State Insurance Fund.
Statewide Average Weekly Wage (SWAWW): A calculated weekly wage based upon the earnings of every worker in Ohio; it is calculated for each year. The figure is used in setting maximum and minimum compensation rates that are paid in claims.
Statute of Limitations: Legal time limitations set by the legislature for an employee to file a workers’ compensation claim.
Stay: Withholding payment or action pending some occurrence or decision.
Surplus Charge: A charge to the surplus fund as opposed to the risk fund of the Bureau or to the self-insuring employer. For example, funeral benefits are paid out of the surplus fund.
Surplus Fund: Fund established as reserve to guarantee solvency of funds to pay certain awards or to pay amounts of reimbursement.
T
Temporary Partial (T.P.): Term used to describe compensation paid as the result of a claimant’s election to receive a partial disability award based on impairment of earning capacity. Also referred to as a “Paragraph A” award.
Temporary Total (T.T.): Temporary total disability compensation, generally paid at 72% of a claimant’s FWW for the first twelve weeks of disability and at 66 2/3% of a claimant’s AWW thereafter.
Tentative Order: An order issued by a claims examiner of the Bureau without a hearing. Either party may file an objection to a tentative order and the issue will then be set for an Industrial Commission hearing with notice to all parties. If no objection is filed, the tentative order becomes a final order.
Timely Payment: Payment by a self-insuring employer being made within the statutory time or time required by rule. For medical bills, no benefits are payable in a disputed claim until the issuance of the SHO order. Compensation payments must be made when a claim is certified or on receipt of an order to pay.
V
Violation of Specific Safety Requirement (VSSR): An award of compensation, which is a penalty to the employer, paid to a claimant when an employer has violated a specific safety requirement and the violation caused an injury.
Vocational Counseling: Counseling by a licensed practitioner regarding job/work adjustment or related issues.
Vocational Evaluation: Identifies transferable skills and vocational aptitudes, provides vocational exploration, individualized career counseling and work simulation.
W
Wage Loss: Compensation for loss of wages due to work-related injury; paid up to a maximum of 200 weeks. Applies only to claims which arose on or after August 22, 1986.
Work Hardening: Therapies geared to physical restoration to meet the requirements of a specific job.
Z
Zone of Employment: Physical area of employment that is under the control of the employer.
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