To help DSPs better understand their Workers' Compensation policies and activities, we have created a quick reference of common abbreviations and acronyms used between yourself, the claims organization and carriers when discussing your policy.
| Term | Definition | Abbreviation |
|---|---|---|
| Term | Definition | Abbreviation |
| Adjuster / Examiner | Manages the claim and issues entitled benefits as per State regulations. Works for third-party administrator as a resource to help employees through your claim and recovery. | CE/ADJ |
| Workers Compensation | A system established under state law that provides payments, without regard to fault, to employees injured in the course and scope of their employment. | WC |
| Insurance Carrier | An company who underwrites an insurance policy. Old Republic (ORIC) is currently the insurance carrier on all VAS program Worker's Compensation policies. | |
| Third Party Administrator | A company engaged to adjust, manage, and make payment on claims in accoradance with a specific insurance policy. Sedgwick is currently the TPA managing claims on all VAS program Worker's Compensation policies. | TPA |
| Average weekly wages | AWW is utilized to determine the amount of benefits an Injured Worker is entitled to in most states. Each state has different rules on calculating the AWW and sometimes forms are required to support their prior wages leading up to their injury. | AWW |
| Independent medical evaluation | An independent medical exam performed by a neutral doctor. The purpose of the examination is to assist the physician in making a medical determination as to causation, current physical impairment, and the necessity of current and future treatment. | IME, QME, AME, IRE |
| Physician | A skilled health-care professional trained and licensed to practice medicine. | MD |
| Maximum medical improvement | MMI is the point at which no further medical care will improve the Injured Worker's condition. | MMI |
| Next office visit | Follow-up medical visit with medical professional for the Claimant to determine ongoing medical treatment recommendations and work status. | NOV |
| Office visit | Office visit with medical professional for the Claimant to discuss how injury occurred , medical treatment necessary for recovery, and work status. | OV |
| Physical therapy | The treatment of physical dysfunction or injury by the use of therapeutic exercise and the application of modalities, intended to restore or facilitate normal function or development. | PT |
| Return to work | A physician's approval for Claimant to return to some level of gainful employment. This may be restricted or full duty. | RTW |
| Subrogation | The process by which reimbursement is sought from another company or person for the cost it is or will be required to pay that resulted from another party's negligence. | SB |
| Settlement | Conclusion of claim by the mutual agreement of parties involved. | SE |
| Disability benefits | Benefit payments that compensate a disabled injured worker for loss of income or earning capacity. | TTD, TPD, PPD, PTD |
| Litigation | A legal proceeding in a court; a judicial contest to determine and enforce legal rights. | LG |
| Plaintiff Attorney | The attorney representing the employee. | PA, AA |
| Defense Counsel | The attorney representing Sedgwick/ Employer/Carrier. | DC |
| Reserves | Reserves are allocation of funds for most probable exposure financial of the claim. Total reserves include indemnity, medical and expense buckets. Indemnity reserve includes wage loss, settlement issued to employee.Medical reserve includes all medical costs to providers for services. The expense category comprises allocation for investigation costs, fees etc. | RS |
| Medical case manager | Nurses partner with the claim examiner to facilitate medical recovery, expedite RTW and mitigate financial exposure through cost containment. Primary Responsibility: Proactively work with medical providers, physical therapist, employer and examiner to assist with recovery and return to work. | MCM, TCM, FCM |