Common Workers’ Compensation Terms

A

• Accepted claim: A claim for injuries in which the insurer agrees your injury or illness is covered by workers’ compensation insurance.
• Accident: See NRS 616A.030
• Accident Benefit: See NRS 616A.035
• Adjuster: See NAC 616A.015
• American Medical Association (AMA): A national physician’s group which publishes a set of guidelines called “Guides to the Evaluation of Permanent Impairment.” In Nevada, any permanent disability is rated under the 2005 guide’s rating schedule.
• Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. If you believe you’ve been discriminated against at work because you’re disabled and want information on your rights under the ADA, contact a U.S. Equal Employment Opportunity Commission office. For the EEOC office in Nevada, call 1-800-669-4000 or 1-800-669-6820 (TTY).
• Appeals Officer (AO): See NAC 616A.040
• Apportionment: A way of figuring out how much of your permanent partial disability is attributable to your current work injury claim and how much is due to other disabilities.
• Average Monthly Wage: See NRS 616A.065

B

• Benefit: A service or right obtained through a workers’ compensation claim.
• Benefit Penalty: See NRS 616A.070

C

• C-1 Form (Notice of Injury or Occupational Disease): Form used to notify your employer of an injury or occupational disease (OD) arising out of and in the course and scope of your employment, You must provide written notice to your employer as soon as practicable, but no later than 7 days after the accident or OD.
• C-3 Form (Employer’s Report of Industrial Injury or OD):
• C-4 Form (Claim for Compensation): If medical treatment is sought for an injury arising out of the course and scope of employment, a medical provider must complete a C-4 form. The treating physician or chiropractor must, within 3 working days after treatment, complete and mail to the employer, the employer’s insurer and third-party administrator, the C-4 form. The form must be filed within 90 days after an accident or OD.
• Casual: See NRS 616A.075
• Catastrophic Injury: See NRS 616A.077
• Certified Vocational Rehabilitation Counselor: See NRS 616A.080
• Claimant: See NAC 616A.060
• Claims Adjuster: An individual who handles workers’ compensation claims for an insurance company, third party administrator or self-insured employer.
• Claims Examiner: See Claims Adjuster.
• Compensation: See NRS 616A.090

D

• Damages: See NRS 616A.095
• Date of Injury: When you got hurt or ill. If your injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated exposures, the date of injury is the date you knew or should have known the injury was caused by work.
• Death Benefits: Benefits paid to surviving dependents when a work injury or illness results in death.
• Denied Claim: A claim in which the insurance company believes your injury or illness is not covered by workers’ compensation and has notified you of the decision.
• Decision & Order: A written decision by a Hearing officer or Appeals Officer which either affirms, reverses or remands a prior determination.
• Disability: A physical or mental impairment that limits your life activities. A condition that makes engaging in physical, social and work activities difficult.
• Disability rating: See Permanent Partial Disability Rating.
• DIR (Division of Industrial Relations): The DIR administers workers’ compensation laws, resolves disputes over workers’ compensation benefits and provides information and assistance to injured workers and others about the workers’ compensation system.

E

• Employee: See NRS 616A.105 & NRS 616A.110; See also NRS 616A.110 to NRS 616A.225
• Employer: See NRS 616A.230
• Ex parte communication: A private communication with a judge regarding a disputed matter without the other party being present or copied with correspondence. An Ex-Parte communication is generally not allowed.

F

• Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave. For more information, contact the U.S. Department of Labor at 1-866-4-USA-DOL.
• Final order: Any order, decision or award made by a workers’ compensation judge that has not been appealed in a timely way.
• Foot: See NRS 616A.240
• Fraud: Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers’ compensation benefits. The penalties for committing fraud are fines up to $150,000 and/or imprisonment for up to five years.

H

• Hand: See NRS 616A.245
• Hearings: Legal proceedings in which a workers’ compensation judge discusses the issues in a case or receives information in order to make a decision about a dispute or a proposed settlement.
• Hearing officer: See NAC 616A.130

I

• Incarcerated: See NRS 616A.250
• In pro per: An injured worker not represented by an attorney.
• Independent contractor: See NRS 616A.255 http://dirweb.state.nv.us/WCS/Handouts/myth.pdf – DIR memo on Independent contractor
• Independent medical examiner (IME): For injuries occurring on and after January 1, 1991, whenever the term “independent medical examiner” is used, the term shall mean “qualified medical examiner.”
• Impairment rating: A percentage estimate of how much normal use of your injured body parts you’ve lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate your permanent disability rating but is different from your permanent disability rating.
• In the course & scope of employment: Your injury must be caused by and happen on the job.
• Injury: See NRS 616A.265
• Insurer: See NRS 616A.270

J

• Judge: Term used to describe the Hearing officer or appeals officer

L

• Light Duty: See modified duty

M

• Manual: See NAC 616A.170
• Maximal medical improvement (MMI): Your condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Once you reach MMI, a doctor can assess how much, if any, permanent disability resulted from your work injury.
• Medical care: See medical treatment.
• Medical Facility: See NRS 616A.273
• Medical treatment: Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care.
• Modified Duty Position: If your treating physician provides you with a written modified duty release that does not allow you to perform your pre-accident job duties, your employer your employer may extend a modified duty job that is within the restrictions placed by your treating physician. See NRS 616C.475(8) and NAC 616C.583.
• Modified Duty Release: Your treating physician may limit your physical activities that may impact your ability to perform your pre-accident job duties.

N

• Nevada Administrative Code (NAC): The Nevada Administrative Code (NAC) contains the Regulations concerning the Workers Compensation Statutes. The Regulations help define, explain and enact the various provisions of the Statutes.
• Nevada Revised Statutes (NRS):
• Notice of hearing: The formal written notice provided by the Hearings and Appeals Divisions that is sent to all interested parties that indicates the date, time and place that the hearing shall take place.

O

• Objective factors: Measurements, direct observations and diagnostic test results that can be overtly observed.
• Occupational Disease (OD):
• Office: See NAC 616A.181

P

• Panel of Treating Physicians and Chiropractors.
• Party: Normally this includes the insurance company, your employer, attorneys and any other person with an interest in your claim (doctors or hospitals that have not been paid).
• Patient: See NAC 616A.190
• Permanent and stationary: See stable and Ratable
• Permanent Partial disability: Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached.
• Permanent Partial disability rating (PPD): A percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, medical records, medical examination.
• Permanent Partial disability (PPD) benefits: Payments you receive when your work injury permanently limits the kinds of work you can do or your ability to earn a living.
• Permanent disability payments: A mandatory bi-weekly payment based on the undisputed portion of permanent disability received before and/or after an award is issued.
• Permanent total disability (PTD) benefits: Payments you receive when you are considered permanently unable to earn a living.
• Physician:
• PPR (Physicians Progress Report):
• Primary treating physician (PTP): The doctor having overall responsibility for treatment of your work injury or illness. This physician writes medical reports that may affect your benefits. Also called treating physician or treating doctor.
• Proof of service: A form used to show that documents have been sent to specific parties.
• PPD Report: A medical report written by a rating physician that describes your permanent partial disability rating

Q

R

• Rating: See permanent partial disability rating.
• Reconsideration: See petition for reconsideration.
• Restrictions: See work restrictions.

S

• Self-insured Employer – See NRS
• Social Security disability benefits: Long-term financial assistance for totally disabled persons. These benefits come from the U.S. Social Security Administration. They are reduced by workers’ compensation payments you receive.
• Stable & Ratable: Your medical condition has reached maximum medical improvement. Once you are stable and ratable, a doctor can assess how much, if any, permanent disability resulted from your work injury.
• Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker’s permanent disability.
• Subpoena: A document that requires a witness to appear at a hearing.
• Subpoena Duces Tecum (SDT): A document that requires records be sent to the requester.

T

• Temporary partial disability (TPD) benefits: Payments you get if you can do some work while recovering, but you earn less than before the injury.
• Temporary total disability (TTD) benefits: Payments you get if you cannot work at all while recovering.
• Third Party Administrator: See NRS 616A.335
• Total Disability: See NRS 616A.340
• “Trade. Business, Profession or occupation of his or her employer”: See NRS 616A350
• Transportation expenses: A benefit to cover your out-of-pocket expenses for mileage, parking and toll fees related to a claim. Usually a reimbursement.
• Treating doctor: See primary treating physician.
• Treating physician: See primary treating physician. Treating physician: A physician that can treat your work injury if you advised your employer in writing prior to your work injury or illness and certain conditions are met.

U

V

• Vocational rehabilitation (VR): See NAC 616A.270
• Vocational rehabilitation maintenance allowance (VRMA): Payments to help you with living expenses while participating in vocational rehabilitation. See vocational rehabilitation.
• Vocational Rehabilitation counselor:
• Vocational Rehabilitation Services: See NRS 615.140

W

• Work restrictions: A doctor’s description of the work you can and cannot do. Work restrictions help protect you from further injury.
• Worker: See employee