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Common Workers' Comp Terms
AOE (Arising Out of Employment): This refers to how the activities of work led to the injury.
Claims Adjuster: Employee of an insurance company, self-insured employer, third-party administrator or other organization who processes or oversees the processing of individual workers’ compensation claims.
COE (Course of Employment): An injury must occur in the “course of employment” to be compensable.
DOI (Date of Injury): The date on which the worker was injured on the job or the date when exposure to an injury occurred.
First Aid: As defined by the California Labor Code, Section 5401, “first aid” means any one-time treatment and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment and follow-up visit for the purpose of observation is considered first aid even when provided by a physician or registered professional personnel. (http://www.dir.ca.gov/dwc/firstaid.htm)
HCO (Health Care Organization): Where an injured worker is referred for evaluation and treatment of a work related injury. (http://www.dir.ca.gov/dwc/HCO.htm)
MPN (Medical Provider Network): The injured worker is referred to a treating medical provider who is part of the “network” contracted by the insurance carrier. (http://www.dir.ca.gov/dwc/HCO.htm)
PTD (Permanent Total Disability): The injured worker is unable to compete in the open labor market due to the results of the injury.
P&S (Permanent and Stationary): The point when the injured worker’s injury has been medically stabilized and further evaluation and treatment is not indicated.
Pre-designation: The employee may designate his/her personal medical doctor as the treating physician for work-related injury or illness. (http://www.dir.ca.gov/dwc/FORMS/DWCForm_9783.pdf)
RTW (Return to Work): Return to work either at regular, modified or alternative job duties. (http://www.dir.ca.gov/dwc/rehab.html)
QME (Qualified Medical Evaluation): A medical evaluation requested by the employee or employer to resolve disagreements over medical issues.
TTD (Temporary Total Disability): A disability that prevents a worker from performing any part of his or her job duties. (http://www.dir.ca.gov/dwc/FactSheets/FactSheet_C.pdf)
TPD (Temporary Partial Disability): A disability that prevents an injured worker from performing all or part of his or her work duties. (http://www.dir.ca.gov/dwc/FactSheets/FactSheet_C.pdf)
UR (Utilization Review): This is requested by the claims administrator to check if the medical provider’s treatment plan is appropriate and necessary for treating the worker’s injury. (http://www.dir.ca.gov/dwc/UR_Main.htm)
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