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GLOSSARY - WORKERS’ COMPENSATION TERMINOLOGY

A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - Q - R - S - T - U - V - W - X - Y - Z

AC-2 Form
AC-26 Form
AC-3 Form
Acceleration
Accidental in Nature
Acute
Adjudicating Committee
Aggravation of Pre-existing Condition
Allowed Condition
“Our exclusive endorsement of BMSO demonstrates the level of confidence our association has in the quality and value of services they provide to our members. You get five star service and five star commitment from them! I recommend them to everyone.”

Lyle Williams – Honorable Lyle Williams Member of Congress 1979-1985
Executive Director NASPAC
Arising Out of Employment (AOE)
Average Weekly Wage (AWW)
Causal Relationship
Certificate of Premium Payment
Chronic
Claim Number
Coming and Going Rule
Compensation
Compline
Date of Injury (DOI)
Disability
Disabled Workers' Relief Fund (DWRF)
Employee
Employer
Ergonomics
Exacerbation
Experience Exhibit
Experience Rating
Fraud
Full and Final Settlement
Full and Weekly Wage (FWW)
Group Rating
Health Partnership Program (HPP)
In The Course of Employment
Industrial Commission of Ohio (IC)
Intentional Tort
International Classification of Disease (ICD-9 Codes)
Independent Medical Examination (IME)
Impairment
Independent Contractors
Job Analysis
Living Maintenance
Lost Time Claim
Lump Sum Advancement
Manual Classifications
Maximum Medical Improvement (MMI)
Managed Care Organization (MCO)
Medical Benefits
Medical Only Claim
National Council On Compensation Insurance (NCCI)
Non-Complying Employer
Occupational Disease
Ohio Bureau of Workers' Compensation (BWC)
One Claim Program
$15,000 Medical Only Program
Pain and Stress Management Program
Partial Payment Plan
Permanent Partial (percentage)
Permanent Partial (scheduled losses)
Permanent Total
Premium Discount Program
Pre-employment or Pre-placement Screening
Premium Rates
Premium Security Deposit
Provider Number
Qualified Health Plan (QHP)
Re-rates
Reserves
Retrospective Rating
RTW
Risk Number
Scope of Employment
Self-Insurance
Statewide Average Weekly Wage (SAWW)
Statewide Disability Evaluation System (SDES)
State-Fund Employer
Subrogation
Third Party Administrator (TPA)
The Ohio Chamber Alliance, Inc.
Temporary Partial
Temporary Total
Transitional Work
Violation of Specific Safety Requirements (VSSR)
Wage Loss
Work Hardening Program
Zone of Employment



AC-2 Form
Permanent authorization of representation for workers' compensation claims administration.
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AC-26 Form
Employer statement for group rating plan enrollment.
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AC-3 Form
Temporary authorization to review and perform studies on certain workers' compensation matters.
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Acceleration
A work-related injury or disease may hasten the development of an underlying condition.
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Accidental in Nature
Sudden, unusual, unexpected occurrence happening at a particular time and place, not in the usual or expected course of events.
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Acute
The time period immediately following an injury, which includes the time expected for normal healing and recovery.
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Adjudicating Committee
A committee composed of BWC employees that renders decisions in accordance with the law and rules of the IC and BWC on requests or grievances filed by employers.
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Aggravation of Pre-existing Condition
A pre-existing condition is worsened by an injury arising in the course of employment.
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Allowed Condition
A medical condition recognized as a direct result of an industrial injury or occupational disease.
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Arising Out of Employment (AOE)
Causal connection between the injury and the performance of required work.
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Average Weekly Wage (AWW)
Used to determine the rate of lost time compensation payment to an injured worker after the first 12 weeks of injury. AWW is based on wages earned the prior year.
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Causal Relationship
Occurs through a natural and unbroken sequence of factors which result in a condition alleged in a claim.
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Certificate of Premium Payment
A certificate issued to an employer that shows effective dates of coverage. It must be conspicuously posted in your place of employment.
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Chronic
Pain or disability that extends beyond the time period expected for normal recovery.
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Claim Number
An identification number assigned to a claim by BWC.
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Coming and Going Rule
Excludes injuries sustained by employees commuting to and from their fixed site of employment.
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Compensation
Money paid by BWC or a self-insuring employer to an employee for lost wages due to a work-related injury or occupational disease.
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Compline
A toll-free service allowing employers, injured workers or medical providers to file a claim by telephone.
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Date of Injury (DOI)
The date an employee suffers an injury or contracts an occupational disease at work.
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Disability
A change of an individual’s capacity to meet personal, social or occupational demands, or statutory or regulatory requirements.
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Disabled Workers' Relief Fund (DWRF)
A fund that provides permanently and totally disabled workers with a supplemental stipend to offset increases in the cost of living.
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Employee
Any person hired by another, or business firm, etc., to work for wages or a salary.
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Employer
One who employs, such as a person, business firm, etc., that hires one or more persons to work for wages or salary.
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Ergonomics
The science that seeks to adapt work or working conditions to suit the worker.
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Exacerbation
Aggravation of systems or increase in the severity of a disease.
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Experience Exhibit
A statement sent to each experience-rated employer that shows how BWC calculated the final experience modification (credit or penalty applied to the base rate.)
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Experience Rating
An incentive system that promotes safe working conditions by providing employers with credits or penalties based on their safety records.
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Fraud
In workers’ compensation, an intentional act or series of acts resulting in payments or benefits to a person or entity not entitled to receive those payments or benefits.
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Full and Final Settlement
Lump sum payment made to an injured worker for the purpose of closing the workers' compensation claim for further medical payments and compensation benefit payment.
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Full and Weekly Wage (FWW)
Used to determine the rate of lost time compensation payment to an injured worker during the first 12 weeks of disability. FWW is based on wages earned the year prior.
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Group Rating
A special application of experience rating in which smaller employers with a particular industry may form a group for rating purposes.
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Health Partnership Program (HPP)
A program in which BWC will contract for medical management and utilization of services with managed care organizations, which must meet specific criteria to provide health-care services to injured workers.
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In The Course of Employment
Circumstances of the occurrence of the injury in terms of time, place and the activities in which the employee was involved at the time of injury.
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Industrial Commission of Ohio (IC)
The claims adjudication branch of the Ohio workers’ compensation system.
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Intentional Tort
A deliberate and intentional act by an employer to injure, cause an occupational disease or cause the death of an employee.
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International Classification of Disease (ICD-9 Codes)
A statistical classification system for medical diagnosis of diseases and injuries used by health care providers to list condition(s) being treated in a workers’ compensation claim.
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Independent Medical Examination (IME)
A medical examination by a specialist in the appropriate field, appointed by BMSO/BWC to examine the injured worker.
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Impairment
A change of an individual’s health status that is assessed by medical means.
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Independent Contractors
An independent contractor is considered an employer and therefore not an employee.
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Job Analysis
A report of the physical and mental demands of a job.
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Living Maintenance
Payment to an injured worker instead of workers’ compensation benefits while he or she is involved in an approved rehabilitation program.
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Lost Time Claim
A claim filed when an employee loses eight or more calendar days from his or her job due to an industrial injury or occupational disease.
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Lump Sum Advancement
An advancement of future compensation given to an employee to enable payment of a sizeable outstanding debts or certain large purchases.
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Manual Classifications
The divisions of industries pursued and work performed by employees upon which BWC determines premium rates.
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Maximum Medical Improvement (MMI)
When an individual’s medical condition has stabilized to the point that no fundamental function or physiological change can be expected within reasonable medical probability, in spite of continuing medical or rehabilitative procedures.
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Managed Care Organization (MCO)
A provider of medical management services, including the establishment of provider networks to serve injured workers, as certified by BWC.
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Medical Benefits
Fees paid for medical services arising from an allowed work related injury or disease.
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Medical Only Claim
A claim filed when an employee loses seven or fewer calendar days from his or her job due to an industrial or occupational disease.
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National Council On Compensation Insurance (NCCI)
Develops manual classifications to be adopted by BWC.
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Non-Complying Employer
Employers who have either allowed their coverage to lapse or who have failed to provide workers’ compensation coverage as required by Ohio Law.
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Occupational Disease
A disease contracted in the course of employment.
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Ohio Bureau of Workers' Compensation (BWC)
The administrative branch of the Ohio workers’ compensation system. Charged with administering claims, setting rates, etc.
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One Claim Program
The OCP is BWC's voluntary rate program for private, state-fund employers currently participating in a group-rating program. The OCP is designed to help employers with minimal claims lessen the financial impact of a single uncharacteristic claim. In order to qualify, the claim must be entering the employer's experience and must have caused removal from a group-rating program. Eligible employers will receive a 40-percent discount off of their base rate for up to four years while the one significant claim remains in their experience.
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$15,000 Medical Only Program
An option for state fund employers in which an employer can elect to pay the first $15,000 of medical bills for medical only claims.
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Pain and Stress Management Program
A clinic-based, comprehensive, multidisciplinary treatment program designed to improve the physical, social, and behavioral functioning of persons with chronic pain.
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Partial Payment Plan
Payment schedule agreed upon by the employer and Bureau of Workers' Compensation in which the employer must make payments on a 30 day basis in order to obtain the certificate of coverage issued by the collection unit.
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Permanent Partial (percentage)
Compensation paid in claims where there is continuing impairment.
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Permanent Partial (scheduled losses)
Compensation provided when an employee loses specific body part(s) or suffers loss of function due to a work-related injury or occupational disease.
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Permanent Total
Compensation, including medical benefits, provided the IC declares an injured worker to be permanently and totally disabled due to a work-related injury or occupational disease.
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Premium Discount Program
A four-year program that offers penalty-rated employers premium discount incentives for creating safe work environments and reducing workplace accident rates.
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Pre-employment or Pre-placement Screening
A functional capacity evaluation performed prior to assignment of a new employee to a job.
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Premium Rates
Rates paid by employers that are based on the degree of hazard and claim history for the approximately 217 industry classifications.
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NOTE: Effective July 1, BWC will begin to phase in an industry re-classification system designed to make workers' compensation premium rates more equitable. BWC is converting its current classifications to those established by NCCI. When the NCCI classifications will increase from 217 to about 630 and BWC will discontinue its current classification system.
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Premium Security Deposit
A deposit, based on an employer’s payroll, that gives the employer an initial 30-day provisional coverage.
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Provider Number
An identification number assigned to each medical provider submitting fee bills for services rendered in workers' compensation claims.
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Qualified Health Plan (QHP)
An arrangement to be implemented by BWC in which a self-insuring employer, state-fund employer, or groups of state-fund employers may contract with a managed care organization and pay medical costs directly.
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Re-rates
The re-rates are Actuarial Corrections done twice a year. The initial calculation for the Group Discount is based on the combined payroll and claims experience of all the employers in a TPA's Group, aggregated together and calculated. The experience period spans a five year history of all the employers in the Group. This calculation is a snapshot in time of that experience information. When the Bureau re-rates Groups, there may have been a number of employer adjustments either to the payroll and/or claims of one or more employers in their Group. When that occurs, and the experience is recalculated there can be a swing in the discount rate that either can increase or decrease the initial Group Discount of those prior payroll periods. When the Discount Rate improves, the Bureau collected too much money and is obligated to return the money to the Group employers in the form of refunds or credits to all the employers in the Group based on the new revised discount rates. When the Discount Rate decreases, the Bureau has to collect additional premiums and all the employers in the Group are invoiced for additional premiums.
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Reserves
The amount charged against lost time claims for future or anticipated costs incurred during the experience period.
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Retrospective Rating
A program in which the employer agrees to assume a portion of the risk in return for a possible reduction in premiums.
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RTW
Return to work.
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Risk Number
An identification number assigned to an employer by BWC. Also known as Policy Number.
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Scope of Employment
Work is directly related to employment.
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Self-Insurance
A privilege granted to large employers with sufficient financial ability to pay workers' compensation claims directly.
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Statewide Average Weekly Wage (SAWW)
The average wage of Ohioans used to establish the minimum and maximum levels of workers' compensation. The SAWW changes annually.
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Statewide Disability Evaluation System (SDES)
A legislatively-mandated monitoring system of medical examinations for injured workers' who have received temporary total compensation for 90 consecutive days.
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State-Fund Employer
Employers who pay premiums into the state insurance fund for workers' compensation coverage.
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Subrogation
Allows BWC to recover from a third party the cost of benefits paid, or to be paid, to an inured worker.
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The Ohio Chamber Alliance, Inc.
A statewide growth association founded in 1991 to provide discounted employee benefit programs to business and industry.
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Third Party Administrator (TPA)
Represents the employer in aspects related to workers' compensation. Such as BMSO.
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Temporary Partial
A disability determination on cases where injury occurred prior to August 22, 1986, which an employee is no longer temporary and totally disabled, but is not yet fully recovered.
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Temporary Total
Compensation awarded for a temporary disability that prevents an employee from returning to his or her job position at the time of injury.
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Transitional Work
An early return-to-work program involving performance or work tasks for pay. These tasks can be safely performed by a worker whose ability to perform the original job has been compromised.
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Violation of Specific Safety Requirements (VSSR)
An award that can pay the injured worker up to an additional 50 percent of the maximum compensation provided by law if the employer is found to be in violation of a specific safety requirement.
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Wage Loss
Compensation available in claims filed for injuries occurring on or after August 22, 1986, where an employee suffers wage loss due to work-related injury.
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Work Hardening Program
A clinic-based, multidisciplinary program that induced the use of real and/or simulated work tasks along with physical reconditioning to improve the functional capacity of an injured worker to perform a targeted job.
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Zone of Employment
Working at a site under the employer’s control.
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