Category: Claim Settlement (Page 4 of 7)

People that work on your workers’ compensation claim tend to use many acronyms. In practice, abbreviations and acronyms help stakeholders convey terms and concepts efficiently. However, most work injury claimants have enough trouble understanding the L&I claim process without throwing acronyms into the mix.

 

Understanding acronyms in your workers’ compensation claim

Over time, I developed a list of acronyms that we use in L&I and workers’ compensation claims. Interestingly, I’m not alone. The Board of Industrial Insurance Appeals (BIIA) also maintains a list of useful acronyms. In fact, they distribute the list alongside a document that they call Jurisdictional History (JH).

 

L&I claim abbreviations and acronyms (A-D)

The list of L&I claim acronyms is long. For reference, below is the list of terms that I find most useful for work injury claimants.

• AP – Attending Physician or Provider. Every claim has an AP, but only one provider can be the designated AP on a workers’ compensation claim. The AP is generally in charge of certifying benefits. They are also responsible for treatment recommendations, making referrals, and managing medication. In many L&I claims, one of the biggest challenges is finding a good attending provider.
• APF – Activity Prescription Form. The AP should complete the APF every 30 days to certify a work injury claimant’s entitlement to time-loss compensation benefits.
• AWA – Ability to Work Assessment. This is part of the vocational process.
• BIIA or Board – The Board of Industrial Insurance Appeals. The BIIA is a separate state agency from the Department of Labor and Industries (L&I). The BIIA hears disputes in workers’ compensation claims.
• BTL – Back Time-Loss Compensation Benefits. The BTL refers to a type of wage replacement benefit that L&I pays retroactively.
• CAC – Claims and Account Center. The CAC is the online system to review and monitor L&I claims. You can only use it for a workers’ compensation claim that L&I administers. People with a work injury claim can create a login so they may access CAC to monitor their L&I claim. Moreover, the website contains lots of useful information. For example, you can find medical records, APFs and claim correspondence. Furthermore, it holds file notes, addresses, contacts, wage rate calculations and payment ledgers. Finally, you can use it to communicate with the Department of Labor and Industries.
• DLI, LNI, or L&I – These are different acronyms for the Department of Labor & Industries.
• DOM – Date of Manifestation. The DOM is the onset date for an occupational disease or industrial disease workers’ compensation claim.
• DOI – Date of Injury. The term DOI holds the date of the sudden and tangible industrial injury.

 

More terms and acronyms in workman’s comp claims (E-L)

To continue the discussion, workers’ compensation professionals also use the following terms frequently:

• EOI – Employer of Injury.
• ESD – Employment Security Department.
• HCB – Health Care Benefits.
• HEP – History Examination Plan. This term comes up often when talking about medical records. L&I personnel like to see the HEP as part of the medical records and chart notes.
• HPI – History of Present Illness (or Injury). The HPI describes the work injury. Sometimes, it describes the mechanism of the work injury. It can also explain the development of an occupational disease over time.
• II – Industrial Injury. A sudden and tangible injurious event during a person’s employment.
• IME – Independent Medical Examination. An IME is a one-time medical examination. Generally, the claim administrator (i.e., L&I or a third party claim administrator in the case of self-insured employer) is responsible to scheduling the exam.
• IW – Injured Worker.
• JA – Job Analysis.
• JH – Jurisdictional History. The BIIA prepares and sends a jurisdictional history. Visually, it looks like a timeline of all L&I claim events. The BIIA sends the JH to parties with an order granting an appeal. This document helps to create a quick timeline of the case. In turn, it helps to establish BIIA’s jurisdiction over the appeal.
• JOI – Job of Injury. The JOI is the job that the work injury claimant held at the time of his or her work injury.
• LEP or LOEP – Loss of Earning Power Benefits. These are a type of wage replacement benefit for workers that can return to work under lower earning capacity. L&I pays LEP only while the workman’s compensation claim is open.

 

Workman’s comp claim terminology (M-Q)

In addition, we also have the following acronyms:

• MH – Mental Health.
• MMI – Maximum Medical Improvement, Medical Fixity, or Fixed and Stable (FAS). MMI is when medical professionals conclude that no additional treatment can help.
• MMPN – Medically More Probable Than Not. The MMPN is the medical legal standard for every workers’ comp claim. It weighs whether a condition is more probably true than not.
• MPN – Medical Provider Network. With very few exceptions, medical providers treating work injury claimants’ must be members of the MPN.
• NC – Nurse Consultant.
• OMD – Office of Medical Director (at L&I).
• ONC – Occupational Nurse Consultant or Office of Nurse Consultant at L&I.
• OD – Occupational Disease. This is a disease or condition caused by distinctive conditions of employment.
• PAC or PA-C – Physician Assistant.
• PCE or PBPCE – Physical Capacity Evaluation or Performance Based Physical Capacity Evaluation. This is an evaluation that helps assess the physical abilities of the work injury claimant.
• PCP – Primary Care Physician.
• PPD – Permanent Partial Disability. The PPD is a monetary award that a person with a work injury claim might receive. L&I pays this award when there are permanent and measurable residual conditions.
• PTD/TPD – Permanently Totally Disabled or Total Permanent Disability. This refers to work injury claimants who are so disabled that they will never be able to return to work.

 

Workers’ comp claim lingo (R-Z)

Finally, the remaining terms and acronyms are available below:

• ROA – Report of Accident. When a medical provider files a claim on your behalf, they fill and submit the ROA report to L&I.
• ROI – Report of Injury.
• RTW – Return to Work.
• SIE – Self-Insured Employer. L&I and Washington State provide funding for some claims. However, for self-insured employers, there are third party administrators that manage the claim.
• SIMP – Structured Intensive Multidisciplinary Program, which is a pain management program. These programs help work injury victims rebuild strength and stamina. The goal of the program is to help you return to work, to address mental health conditions, chronic pain, vocational issues, and others.
• SM – Secure Message. You can communicate with your L&I claim manager by sending them a secure message through CAC.
• TBI – Traumatic Brain Injury.
• TL or TLC – Time-Loss Compensation Benefits. It’s a type of wage replacement benefit that L&I pays to people after a work injury. Here, L&I sends out payments every two weeks to workers that cannot work due to their industrial injury or occupational disease.
• TPA – Third Party Administrator. The TPA manages and administers workman’s comp claims for self-insured employers.
• TTD – Temporary Total Disability. If you had a work injury and you’re temporarily disabled, then L&I will pay time-loss benefits. Yet, to qualify, you must certify the TTD every 30 days with your physician.
• VDRO – Vocational Dispute Resolution Office.
• VOC – Vocational Services.
• VRC – Vocational Rehabilitation Counselor.
• WSF or WVF – Work Status Form. This is a form that work injury claimants must complete every 30 days to declare their entitlement to TLC. Previously, it was called a Worker Verification Form (WVF).

 

Summary and conclusions

In conclusion, while this list is a good start, there are many acronyms in the workers’ compensation claim settings. In fact, some are not available in the list above. Consequently, if you encounter an unfamiliar acronym in your workman’s compensation claim, you can simply ask what it means. After all, people working on workers’ comp claims use acronyms very frequently. Unfortunately, sometimes they forget that others don’t necessarily know what they mean.