|
A
accepted
condition - A medical condition for which an insurer
accepts responsibility for the payment of benefits on a
claim filed by an injured worker. Insurer provides written
notice of accepted conditions. (ORS 656.262) The insurer
generally will accept specific conditions based on the diagnosis
by the physician or nurse practitioner. It is important
that the health care provider report a diagnosis rather
than a symptom.
administrative law judge - An employee of the Workers'
Compensation Board who reviews appealed administrative orders,
holds impartial hearings, and issues legal opinions.
aggravation claim - A claim for further benefits
because of a worsening of the claimant's accepted medical
condition after the claim has been closed. Aggravation rights
expire five years after first closure on disabling claims
or five years from date of injury on non-disabling claims.
(ORS 656.273)
alternative dispute resolution (ADR) - A voluntary
process through which parties resolve disputes instead of
using the formal hearing process.
American National Standards Institute (ANSI) - A
private non-profit organization that oversees the development
of voluntary consensus standards for products, services,
processes, systems, and personnel in the United States.
The organization also coordinates U.S. standards with international
standards so that American products can be used worldwide.
Americans with Disabilities Act (ADA) - A federal
act directing employers to make reasonable accommodations
for people with disabilities.
ancillary care - Care such as physical or occupational
therapy provided by a health care provider other than the
attending physician, specialist physician, or authorized
nurse practitioner.
appeal rights - Legal rights that any party may exercise
when not satisfied with an insurer's decision, action, or
order.
assigned claims agent - The company contracted to
process claims referred under a noncomplying employer order.
assigned processing agent - The company contracted
to process and pay supplemental disability benefits to injured
workers on behalf of the Workers' Compensation Division.
attending physician - A health care provider primarily
responsible for the treatment of an injured worker. (ORS
656.005)
authorized nurse practitioner - A nurse practitioner
authorized by the director to provide compensable medical
services to an injured worker for a period of 90 days from
the date of the first visit to a nurse practitioner on the
initial claim. The nurse practitioner also may authorize
temporary disability benefits for a period of up to 60 days
from the first visit to a nurse practitioner on the initial
claim.
authorized training plan (ATP) - A contract between
the insurer and worker regarding the type of training that
the worker will complete as well as the responsibilities
of both parties during the course of the training plan.
average weekly wage (AWW) - The
Oregon average weekly wage of workers in covered employment,
as determined by the Employment Department. (ORS 656.211)
The AWW affects the rate of temporary disability, permanent
partial disability, permanent total disability, and death
benefits. (ORS 656.204, 656.208, 656.210, 656.212, 656.214)
Back to top
B
beneficiary
- An injured worker's spouse, domestic partner, child, or
dependent entitled to receive payments under workers' compensation
law. (ORS 656.005)
board - The Workers' Compensation Board of the Department
of Consumer and Business Services.
board review - The appeal level following a hearing
before an administrative law judge of the Workers' Compensation
Board Hearings Division.
board's own motion (BOM) - The
reopening of a workers' claim after aggravation rights have
expired for a worsening, new, or omitted medical condition
claim. ORS 656.278
bulletin - A director/administrator approved release
of information outside the agency regarding legal provision,
requirements and/or administrative rules.
Bureau of Labor and Industries (BOLI) - The state
agency that investigates discrimination in the workplace
and enforces employee rights.
business identification number (BIN) - The number
assigned to a business by the Oregon Department of Revenue
(printed on the employer's Oregon tax coupons). This number
is used by the Oregon Employment Department and the Oregon
Department of Consumer and Business Services to keep track
of taxes and workers' compensation premium assessments and
contributions.
Back to top
C
certified rehabilitation counselor - A certified
vocational counselor on staff of an authorized vocational
assistance provider, insurer, or self-insured employer.
claim - A written request by the worker, or on the
worker's behalf, for compensation.
claim closure - The process of closing a claim and
determining permanent disability when an injured worker
is found to be medically stationary.
claim disposition agreement (CDA) - An agreement
between the parties to a workers' compensation claim. The
worker agrees to sell back his or her rights (e.g., rights
to compensation, attorney fees, expenses) except medical
and preferred-worker benefits on an accepted claim. Also
known as a "C&R" or a "compromise and
release." (ORS 656.236)
claimant - A person who files a claim for occupational
disease or injury benefits under workers' compensation law.
claims
examiner - An insurer representative who processes claims
filed by workers.
claims information system (CIS) - The computer data
system the Workers' Compensation Division uses to track
activity and status of claims that are required to be reported
to the division (only disabling and denied claims must be
reported).
CLE - Continuing legal education. Active members
of the Oregon State Bar are required to complete a minimum
number of credit hours of CLE activities to maintain their
status.
closed claim - A claim for which the insurer or the
Workers' Compensation Board has issued a Notice of Closure.
closing examination - A medical examination to measure
a worker's impairment, which occurs when the worker is medically
stationary.
combined condition - Occurs when a pre-existing condition
combines with a compensable condition. A combined condition
may cause disability or prolong treatment. (ORS 656.005)
compensable fatality claims - Compensable fatalities
are claims accepted by insurers during the year resulting
from a fatal occupational injury or disease that entitles
workers and their survivors to compensation. Data exclude
deaths of non-covered workers, such as workers who were
self-employed, worked in Oregon for out-of-state employers,
city of Portland police and fire employees, or federal employees.
compensable injury - An accidental injury to a person
or prosthetic appliance, arising out of and in the course
of employment that requires medical services or results
in disability or death. (ORS 656.005) A claim is compensable
when it is accepted.
consequential condition - A condition arising after
a compensable injury and for which the major contributing
cause is the injury or treatment rendered that increases
either disability or need for treatment. (ORS 656.005)
consulting physician - A physician who advises the
attending physician or authorized nurse practitioner regarding
the treatment of a worker's injury.
Consumer and Business Services Fund - The major operating
fund of the Workers' Compensation Division and workers'-compensation-related
functions of other divisions within the Department of Consumer
and Business Services. (ORS 656.612)
contested-case hearing - A formal proceeding at which
parties can present evidence in support of their case to
an administrative law judge who issues an order resolving
the dispute.
Court of Appeals - The level of appeal for workers'
compensation disputes following a Workers' Compensation
Board review or director review after hearing.
curative care - In the workers' compensation system,
treatment to stabilize a temporary waxing and waning of
symptoms after a worker is medically stationary. (ORS 656.245)
CY - The calendar year (Jan. 1 through Dec. 31).
Back to top
D
de facto denial - The failure of an insurer to accept
or deny a claim within the statutory time frame. The insurer
has 60 days to accept or deny a claim.
deferred claim - A claim not yet accepted or denied
by the insurance company or self-insured employer.
degree - For dates of injury before Jan. 1, 2005,
a unit of measure for permanent partial disability benefits
that is used to convert disability percentages to dollar
amounts.
denied claim (denial) - A written refusal by an insurer
to accept compensability or responsibility for a worker's
claim of injury. (ORS 656.262)
department - See the Department of Consumer and Business
Services.
Department of Consumer and Business Services (DCBS)
- The state agency consisting of the Workers' Compensation
Division, Workers' Compensation Board, Oregon OSHA, Insurance
Division, Building Codes Division, Division of Finance and
Corporate Securities, Ombudsman for Injured Workers, Small
Business Ombudsman, and other offices and programs.
Department of Justice (DOJ) - The state agency that
provides legal representation to other state agencies. The
attorney general is the head of the Department of Justice.
designated paying agent - The insurer temporarily ordered
to pay benefits for a compensable injury until responsibility
for the claim is determined. (ORS 656.307)
disability payment - The payment for disability resulting
from an accident or disease from which a worker is not expected
to recover. Determined at the time the condition becomes
medically stationary. May be partial or total. See also
permanent partial disability and permanent
total disability
disabling claim - Any injury is classified as disabling
if it causes the worker temporary disability (time-loss),
permanent disability, or death. The worker will not receive
time-loss benefits for the first three days unless he or
she is off work and not released to return to any work for
the first 14 consecutive days or is admitted to a hospital
as an inpatient during the first 14 consecutive days. The
claim is also classified as disabling if there is a reasonable
expectation that permanent disability will result from the
injury.
disabling compensable injury - An on-the-job injury
that entitles the worker to temporary, permanent partial,
or total disability payments, or results in death benefits.
(ORS 656.005)
disputed-claim settlement (DCS) - A DCS is a settlement
of a workers' compensation claim in which the worker gives
up all rights to benefits for the entire claim or for a
specific medical condition. If the DCS settles the entire
claim, the claim remains forever denied, the worker has
no right to any medical benefits, and medical bills are
not paid by the insurer except as specified in the DCS or
unless they were paid as interim medical benefits. Oregon
law requires that, under a DCS, health care providers be
reimbursed for medical services at half the amount allowed
by the fee schedule; however, total reimbursement to health
care providers cannot exceed 40 percent of the total settlement.
Generally, only those bills that have been received by the
insurer are included in the DCS.
division - The Workers' Compensation Division of
the Department of Consumer and Business Services.
Back to top
E
electronic data interchange (EDI) - The electronic
transmission of data such as workers' compensation claims
data, coverage data, and medical bills data.
employer - Any person who contracts to pay for work
or services, with the right to direct and control the work
or services of any person. (ORS 656.005) See also subject
employer.
employer-at-injury - A worker's employer at the time
the worker was injured.
employer data system (EDS) - The Workers' Compensation
Division's database used to capture coverage data for Oregon
employers.
employer knowledge date (EKD) - The date on which
an employer has notice or knowledge of a worker's claim.
Employer's Liability Law - An Oregon law requiring
employers to exercise a higher degree of care for their
employees and the public in work involving risk or danger.
employment purchases (EP) - Tools, equipment, clothing,
tuition, and other purchases through the Preferred Worker
Program that are necessary for a worker to find, accept,
or continue employment.
exclusive remedy - One of the basic concepts of workers'
compensation - that an employee injured on the job is entitled
to workers' compensation benefits but may not sue the employer
for damages. Workers' compensation is thus the exclusive
remedy for a work-related injury.
experience rating modification - A calculation that
compares the employer's actual claims experience to the
average for the employer's type of business. If the employer's
experience is better than average, it gets a rating lower
than 1.00. If it is worse than average, it gets a rating
that is higher than 1.00. This rating affects the cost of
the employer's workers' compensation premium.
extraterritorial coverage - Oregon workers performing
temporary work in other states receive benefits for an injury
as if the workers were in Oregon.
extraterritorial reciprocity - Oregon honors the
extraterritorial coverage of other states as long as the
other states honor Oregon's extraterritorial coverage.
Back to top
F
federal employer identification number (FEIN) - A number
assigned to a business by the Internal Revenue Service.
Form 801 - Report of Job Injury or Illness - A form
used by workers and employers to report a work-related injury
or occupational disease.
Form 827 - Worker's and Physician's Report for Workers'
Compensation Claims - A form used by workers and physicians
to report a work-related injury or illness to insurers. It
can be used as a first report of injury, report of aggravation,
notice of change of attending physician, progress report,
closing report, and palliative care request.
Form 1502 - Insurer Report - A form used by insurers
to make claim status reports to the Workers' Compensation
Division.
Back to top
G
Geographical service area (GSA) - An area of the state
in which a managed care organization is authorized by the
director of the Department of Consumer and Business Services
to operate. There are 15 geographical service areas in Oregon.
guaranty contract - A contract between the insurer
and the department in which the insurer agrees to assume without
monetary limit the liability of an employer for prompt payment
of benefits for compensable injuries. Starting July 1,
2009, the law changed and insurers are no longer using guaranty
contracts.
Back to top
H
Handicapped Workers Program - See Workers
with Disabilities Program.
health care provider - A person duly
licensed to practice one or more of the healing arts. See
also medical service provider.
hearing - A formal proceeding at which parties can
present evidence in support of their case to an administrative
law judge who issues an order resolving the dispute.
HIPAA (Health Insurance Portability and Accountability
Act) - A federal law that ensures the privacy and security
of protected health information and patients' access to their
health-care records.
House Bill (HB) - A legislative bill initiated in the
House of Representatives of the Oregon Legislature.
Back to top
I
impairment findings - A permanent loss of use or function of a body part
or system as measured by a physician. (OAR 436-035-0005)
independent contractor - A person contracted to do work who is not subject
to the direction and control of an employer. Unless independent contractors purchase
workers' compensation insurance coverage for themselves, they cannot collect
benefits for on-the-job injuries or illnesses. (ORS 656.005, 670.600)
independent medical examination (IME) - A medical examination of an injured
worker by a physician other than the worker's attending
physician performed at the request of the insurer. This includes physical capacity
evaluations and work capacity evaluations, if requested by the
insurer. The insurer or self-insured employer pays for this examination.
industry notice - A singular and urgent official agency communication
informing groups that have an interest in the workers' compensation system of
new information, processes, requirements, and changes affecting the workers'
compensation system.
initial claim - The first open period on the claim immediately following
the original filing of the occupational injury or disease claim until the worker
is first declared medically stationary by an attending physician or authorized
nurse practitioner.
inpatient - An injured worker admitted to a hospital before and extending
past midnight for treatment and lodging. (OAR 436-010-0005)
insured employer - An employer who has workers' compensation insurance
to cover work injuries of subject workers. ORS 656.005
insurer - An insurance company authorized to transact workers' compensation
insurance in Oregon, a self-insured employer, or a self-insured employer group.
interim compensation - The time-loss benefits paid for the period between
the filing of a claim and acceptance or denial of the claim.
interim medical benefits - The benefits paid by the insurer during the
interim period limited to some diagnostic services, medication required to alleviate
pain, or services required to stabilize the worker's claimed condition and to
prevent further disability.
interim period - The period beginning when an employer first learns of
a claim and ending when the insurance company accepts or denies the claim.
International Association of Industrial Accident Boards and Commissions (IAIABC)
- The International Association of Industrial Accident Boards and Commissions,
an association of government workers' compensation regulatory agencies.
Back to top
J
job analysis (JA) - A detailed report outlining the
specific job duties of a worker related to the physical requirements
of the job.Job Training
Partnership Act (JTPA) - Provides job-training services
for economically disadvantaged adults and youths, dislocated
workers, and others who face significant employment barriers.
Back to top
L
litigation
- A legal process that usually results in a judge deciding
the resolution of the dispute based on the facts and the law.
lump sum - The payment of a permanent disability award
in one check. Awards that are less than $6,000 are always
paid in a lump-sum. Workers may request lump sum payments
for awards greater than $6,000 instead of receiving monthly
payments. (ORS 656.230)
Back to top
M
major
contributing cause (MCC) - A cause deemed to have contributed
more than 50 percent to an injured worker's disability or
need for treatment.
managed care organization (MCO) - An organization that
contracts with an insurer to provide medical services to injured
workers. (OAR 436-015, ORS 656.260)
Management-Labor Advisory Committee (MLAC) - A committee
made up of management and labor representatives appointed
by the governor that advises the director of the Department
of Consumer and Business Services.
mediation - The act of facilitating agreement and settling
differences between disputing parties.
Medical Advisory Committee (MAC) - A committee whose
members are appointed by the Director of the Department of
Consumer and Business Services. The committee provides advice
to the director on matters relating to the provision of medical
care to workers.
medical arbiter - A physician selected by the director
to perform an impartial examination for impairment findings.
(ORS 656.268)
medical fee schedule - The maximum charges for medical
services in workers' compensation claims, issued as the Oregon
Medical Fee and Payment Rules (OAR 436 Division 009).
medical only - A workers' compensation
claim that does not result in time loss or permanent disability
but requires only medical treatment. See also non-disabling
claim.
medical provider - A health care provider,
hospital, medical clinic, or vendor of medical services. (OAR
436-010-0005)
medical sequela - A condition that originates or stems
from the accepted condition, as determined by a health care
provider. ORS 656.268
medical service - Medical, surgical, diagnostic, chiropractic,
dental, hospital, nursing, ambulance, drug, prosthetic, or
other physical restorative services. (ORS 656.245, OAR 436-010-0005)
medical service provider - A person licensed to practice
one or more of the healing arts. See also health
care provider. (OAR 436-010-0005)
medically stationary - The point at which a worker's
medical status is not expected to improve, either from more
medical treatment or the passage of time. (ORS 656.005)
modified work - A modification to an injured worker's
job duties or work schedule to accommodate the physical limitations
resulting from the injury or disease.
Back to top
N
national provider identifier (NPI) - A unique identification
number assigned to health care providers, individuals, groups,
or organizations that provide medical or other health services
or supplies.
new medical condition claim - A worker's written request
that the insurer accept a new medical condition related to
the original occupational injury or disease.
noncomplying employer (NCE) - An
employer who fails to provide workers' compensation coverage
when the employer has one or more subject workers. (ORS 656.017)
nondisabling claim - A worker's compensation
claim that does not result in time-loss or permanent disability,
but requires only medical treatment. See also medical
only.
nondisabling injury - An injury is classified as nondisabling
if it does not cause the worker to lose more work time than
the three-day waiting period, it requires medical services
only, and the worker has no permanent impairment. ORS 656.005.
Notice of Acceptance (NOA) - A notice from the insurer
or self-insured employer that informs the worker that the
worker's claim has been accepted.
Notice of Closure (NOC) - Form 1644 - A document sent
by the insurer to the worker that closes the claim and states
the extent of permanent disability. (ORS 656.268)
Notice of Compliance - A notice that must be posted
in the employer's place of business, which shows the employer
has complied with workers' compensation insurance coverage
requirements.
Notice of Ineligibility - A notice from the insurer
informing an injured worker that the worker is not eligible
to receive vocational assistance benefits.
Back to top
O
OAR - Oregon Administrative Rule. State agencies adopt
rules to implement law or policy, or describe procedural requirements.
The Workers' Compensation Division's rules are in OAR chapter
436; the Workers' Compensation Board's rules are in OAR chapter
438.
objective findings - The indications of injury or disease
that are measurable, observable, and reproducible, used to
establish compensability and determine permanent impairment.
occupational disease - A disease or infection, arising
out of and occurring in the course and scope of employment.
It is caused by substances or activities to which an employee
is not ordinarily subjected or exposed other than during employment
and requires medical services or results in disability or
death. (ORS 656.802)
Occupational Safety and Health Administration (OSHA)
- The federal agency that oversees workplace safety and health
in federal offices and in states without state OSHA programs.
See also Oregon Occupational Safety and Health
Division.
OED - The Oregon Employment Department.
Office of Vocational Rehabilitation Services - The
office within the Oregon Department of Human Services that
helps disabled people find employment.
offset - A reduction of compensation to a worker to
recover an overpayment or because the worker is receiving
federal social security disability benefits. (ORS 656.209,
656.268)
Ombudsman for Injured Workers - The Department of Consumer
and Business Services office that serves as an independent
advocate for injured workers in the workers' compensation
system.
omitted medical condition claim - A worker's written
request that the insurer accept a medical condition the worker
believes was incorrectly omitted from the Notice of Acceptance.
open status - A claim not yet closed by a Notice of
Closure. The worker may be receiving temporary disability
payments and medical treatment or vocational rehabilitation
assistance while the claim is "open."
opinion and order - A formal decision issued by an
administrative law judge at the Workers' Compensation Board
that resolves a dispute.
Oregon Association of Rehabilitation
Professionals (OARP) - A professional organization of
vocational providers.
Oregon Court of Appeals - The next level of appeal
for workers' compensation disputes after review at the agency
or administrative level.
Oregon Occupational Safety and Health
Administration (Oregon OSHA) - A division of the Department
of Consumer and Business Services that oversees workplace
safety and health in Oregon.
Oregon Revised Statutes (ORS) - The laws as adopted
by the Oregon Legislature.
outpatient - An injured worker who is not admitted
overnight to a hospital for treatment and lodging. "Overnight"
means beginning before and extending past midnight. (OAR 436-010-0005)
overpayments - Money paid to an injured worker by the
insurer that is more than is due the worker.
OWI - Oregon Wage Information.
own motion claim - See Board's Own Motion.
Back to top
P
palliative care - Medical services rendered to reduce or temporarily moderate the intensity of
an otherwise stable condition to enable the worker to continue employment or training. (ORS 656.005, 656.245)
partial denial - Denial by the insurer of one or more
conditions of a worker's claim, leaving some conditions of
the claim accepted as compensable.
penalties - An action taken against a party for violations
of workers' compensation laws or rules, such as monetary fines
or suspension of benefits.
permanent impairment - The permanent loss of use or
function of a body part or system due to a compensable injury.
permanent partial disability (PPD)
- The permanent loss of use or function of any portion of
the body as defined by ORS 656.214.
permanent total disability (PTD)
- The loss of use or function of any portion of the body,
in combination with any pre-existing disability that permanently
prevents the worker from regularly performing gainful and
suitable work. (ORS 656.206)
physical capacity evaluation (PCE) - Measurements of
a worker's ability to perform a variety of physical tasks.
pre-existing condition - A medical condition that existed
before the compensable injury or disease.
preferred worker - An Oregon worker who, because of
permanent disability resulting from a compensable injury or
occupational disease, is unable to return to previous (regular)
employment and meets the eligibility criteria for the Preferred
Worker Program.
preferred worker identification card - A card that
lets employers know the preferred worker is participating
in a state program to help him or her get back to work.
Preferred Worker Program (PWP) - A program that provides
employer incentives for the re-employment of Oregon workers
whose on-the-job injuries have resulted in permanent disabilities.
(OAR 436-110)
premium - The amount of money an employer pays an insurance
company for a workers' compensation policy.
premium assessment - A tax paid by employers, based
on their workers' compensation insurance premiums, that funds
workers' compensation and safety administration programs.
Insurers collect the premium assessment monies and remit them
to the Department of Consumer and Business Services.
preponderance of evidence - Evidence that is of greater
weight or more convincing than evidence on the other side
of the issue. In workers' compensation, the term is often
used in relation to weighing medical opinion.
primary care physician - A physician qualified to be
an attending physician (see attending physician) who is a
general practitioner, family practitioner, or internal medicine
practitioner. When an injured worker is enrolled in a managed
care organization, he or she can choose to treat with a primary
care physician who does not belong to the managed care organization
if the physician maintains the worker's medical records and
has a documented history of prior treatment to the worker
and agrees to abide by the terms and conditions of the managed
care organization.
private rehabilitation organization (PRO) - A private
firm that provides or manages vocational rehabilitation services
for injured workers on behalf of an insurer.
Professional Employment Organizations (PEO) - A term
used to refer to worker leasing companies; this term is used
more frequently in other states and by the leasing industry.
pro se - A party that participates in a formal or informal
dispute process without an attorney.
prosthetic appliance - The artificial substitution
for a missing body part, such as a limb or eye, or any device
that augments or aids the performance of a natural function,
such as a hearing aid or glasses.
pure premium rates - The base premium that reflects
the actual cost of paying workers' compensation claims, projected
for a given year.
Back to top
R
reciprocal or reciprocity agreement - An agreement
between states regarding jurisdiction in workers' compensation
claims. (ORS 656.126)
reconsideration - A review by the director of a claim
closure at the request of an insurer or injured worker. (OAR
436-030-0005)
reconsideration order - An order issued by the director
following its review of a claim closure.
Re-employment Assistance Program - A program that encourages
early return to work of injured workers. See Employer-at-Injury
Program and Preferred Worker Program. (ORS 656.622)
regular work - The job the worker held at the time
of injury or a substantially similar job.
Reopened Claims Program - A program that funds costs
of claims reopened by the Workers' Compensation Board or the
insurer after the five-year aggravation rights on the claim
have expired. (ORS 656.625)
Request for Reconsideration - Form 2223 - A form used
by workers and insurers to request reconsideration of a claim
closure.
Retroactive Program - A program that provides cost-of-living
increases to workers or beneficiaries whose statutory benefits
are lower than those currently being paid. (ORS 656.506)
Back to top
S
SAIF
Corporation - See State Accident Insurance
Fund Corporation.
sanctions - An action taken against a party for violations
of workers' compensation law or rules, such as monetary fines
or suspension of benefits.
scheduled disability - For dates of injury before Jan.
1, 2005, the complete or partial loss of use or function of
an arm, hand, leg, foot, or other extremity of the body, or
the loss of visual or hearing ability. (ORS 656.214)
security - Deposits, bonds, assignments, and certificates
of title provided by self-insured employers to guarantee payment
of compensation for injuries or other existing debts. (ORS
656.407, 656.430)
self-insured employer - An employer that directly assumes
financial and processing responsibility for workers' compensation
benefits rather than purchasing an insurance policy. A self-insured
employer must meet certain financial qualifications and be
certified by the Workers' Compensation Division.
Senate Bill (SB) - A bill initiated in the Senate of
the Oregon Legislature.
service company - A company contracted by a self-insured
employer or insurer to administer its workers' compensation
claims. Also called a third-party administrator.
Small Business Ombudsman - The Department of Consumer
and Business Services office that assists small businesses
with the workers' compensation system.
Social Security offset - A reduction of permanent total
disability benefits based upon the amount of federal Social
Security disability benefits received by a worker.
specialist physician - A specialist physician is a
physician who qualifies as an attending physician but does
not assume the role of attending physician. A specialist physician
examines an injured worker or provides specialized treatment,
such as surgery or pain management, at the request of the
attending physician or authorized nurse practitioner. During
the time you provide specialized treatment, the attending
physician continues to monitor the injured worker and authorizes
any time loss.
State Accident Insurance Fund Corporation
(SAIF) - The publicly owned insurance company that sells
workers' compensation insurance to Oregon employers.
state's average weekly wage (SAWW) - See average
weekly wage.
stipulation - An agreement reached between an insurer
and worker.
subject employer - An Oregon employer
that employs one or more subject workers, and, therefore,
is required to provide workers' compensation insurance coverage
for those workers. (ORS 656.023)
subject worker - All workers in Oregon
who are not specifically exempt from Oregon's workers' compensation
laws. (ORS 656.027)
superimposed condition - A condition arising after
and not related to the compensable injury that increases disability
or need for treatment.
supplemental disability - Additional wage loss replacement
due a worker employed in more than one job at the time of
injury.
suspension of benefits - An interruption of payment
of benefits to an injured worker. (ORS 656.268, 656.325)
Back to top
T
temporary
partial disability benefits (TPD) - Payment for wages
lost when a worker is only able to perform modified or part-time
work because of a compensable injury. (ORS 656.212)
temporary total disability benefits (TTD) - Payment
for wages lost when a worker is unable to work because of
a compensable injury. (ORS 656.210)
third-party administrator - A company
contracted by a self-insured employer or insurer to administer
its workers' compensation claims. Also called a service company.
three-day wait - The waiting period before a worker's
time-loss benefits begin. Waived only if a worker is admitted
as an inpatient to a hospital or is off work for at least
14 calendar days.
three-way system - A workers' compensation system in
which employers can provide workers' compensation coverage
in one of three ways: private insurance, a state fund, or
self-insurance.
time-loss benefits - Compensation due to an injured
worker who loses time or wages because of a compensable injury.
Time-loss benefits include temporary partial disability and
temporal total disability. (ORS 656.212, 656.210, 656.262)
time-loss computation - Generally, compensation equal
to 662/3 percent of gross wages of the worker, but not more
than 133 percent of the state's average weekly wage or less
than 90 percent of the worker's weekly wages or $50 a week,
whichever is less. (ORS 656.210)
type "A" attending physician - A medical
doctor, doctor of osteopathy, or oral and maxillo-facial surgeon
as defined in ORS 656.005(12)(b)(A).
type "B" attending physician - A chiropractic
physician, naturopathic physician, podiatric physician, or
physician assistant as defined in ORS 656.005(12)(b)(B).
Back to top
U
unrelated
condition - A medical or physiological problem not medically
related to the injury.
unscheduled disability - For dates of injury before
Jan. 1, 2005, the impairment to those body parts not listed
as scheduled.
Back to top
V
vocational rehabilitation counselor - A certified vocational
counselor hired by the insurer to provide vocational assistance
to the injured worker.
Vocational Rehabilitation Organization (VRO) - A business
that provides, at an insurer's request, vocational assistance
to injured workers.
Back to top
W
work capacity
evaluation (WCE) - A physical-capacity evaluation that focuses on the ability
to perform work-related tasks.
worker - Any person who provides services for pay under the direction
and control of an employer. See also subject worker. (ORS 656.005)
worker leasing company - An entity that provides workers, by contract
and for a fee, to work for a client; does not include an entity that provides
workers to a client on a temporary basis. (ORS 656.850)
worker-requested medical examination (WRME) - An impartial examination
available to an injured worker when an insurer has issued a
denial of compensability claim based on an independent medical exam and the injured
worker's physician does not concur with the findings (ORS 656.325).
Workers' Benefit Fund - A fund for financial management of cents-per-hour
assessment revenues and expenses. This fund supports benefits distributed from
a number of programs, such as Workers with Disabilities Program, Re-employment
Assistance Program, Reopened Claims Program, and Retroactive Program.
Workers' Benefit Fund assessment - An assessment paid by workers and employers.
Workers' Compensation Board (WCB) - The part of the Oregon Department
of Consumer and Business Services responsible for conducting hearings and reviewing
legal decisions and agreements that affect injured workers' benefits.
Workers' Compensation Division (WCD) - The division of the Oregon Department
of Consumer and Business Services that administers, regulates, and enforces Oregon's
workers' compensation laws.
Workers with Disabilities Program - A program established
to encourage the employment or re-employment of workers with disabilities. Previously
called the Handicapped Workers Program. (ORS 656.628, OAR 436-040)
worksite modification - The changes made to an injured worker's job, tools,
tasks, or worksite to accommodate the worker's injury-caused limitations.
Back to top |
