Workers' Compensation and Disability/Automotive Insurance

A collection of vocabulary flashcards designed for understanding key terms and concepts related to workers' compensation and disability insurance.

Occupational Safety and Health Administration (OSHA)

An organization created by Congress to protect workers from health and safety risks on the job.

Federal Employees’ Compensation Act (FECA)

A law that provides workers’ compensation insurance for civilian employees of the federal government.

Workers’ Compensation Insurance

Insurance that provides wage replacement and medical benefits to employees injured in the course of employment.

Medical benefits

Coverage for medical expenses resulting from work-related illness or injury.

Lost wages

Payment provided to workers while they are unable to work due to illness or injury.

Eligibility exclusions in state plans

Individuals not typically covered include federal employees, self-employed individuals, and volunteers.

Occupational Disease

A condition caused by the work environment over a period longer than one workday or shift.

Fatal injuries benefits

Compensation provided to the survivors of an employee who died as a result of a work-related injury.

Classification of Work-Related Injuries

Categories include injury without disability, temporary disability, permanent disability, and injury requiring vocational rehabilitation.

First report of injury

A document filed in state workers’ compensation cases detailing employer and accident information.

Final report

Document filed by the physician in a state workers’ compensation case when the patient is discharged.

Independent medical examination (IME)

An assessment conducted by a physician to determine an individual's disability status.

Social Security Disability Insurance (SSDI)

A federal program providing compensation for lost wages to individuals who have contributed to Social Security.

Supplemental Security Income (SSI)

A program providing financial assistance to individuals who are disabled and have low income.

Subrogation

The process by which an insurance company seeks reimbursement for claims paid from the at-fault party.

Personal Injury Protection (PIP)

Coverage for medical expenses following a motor vehicle accident.

Occupational Safety Standards

Regulations set by OSHA to guard against known workplace dangers.

Responsibility of the Physician of Record

Treating the injured worker, determining disability, and filing progress notes.

Notification of Determination

Employer's communication to deny liability for a workers' compensation claim.

Claim Management

Processes involved in handling and filing claims related to workers’ compensation.

Progress Report

Document filed when a patient's medical condition changes in a workers’ compensation case.

HIPAA Privacy Rule

Regulations that allow the disclosure of PHI in workers’ compensation cases without patient authorization.

BILLING TIP for Claims

Track claim filing dates to ensure insurance carriers process payments within the stipulated time frame.

Injury requiring vocational rehabilitation

A condition that necessitates training to help an injured worker return to the workforce.

Duration of Benefits

Benefits may be terminated due to various conditions, such as returning to work or exhaustion of maximum benefits.

Disability Compensation Programs

Programs including SSDI, SSI, and veterans' disability programs that provide financial support to disabled individuals.

Diagnostic Reporting

The process of summarizing a patient's medical and symptomatic history relevant to disability claims.

Claim Number

A unique identifier used to track and manage individual workers’ compensation claims.

Medical History for Disability Reports

Abstracted information about a patient’s past health issues pertinent to their current disability.

Financial responsibility in the revenue cycle

The process of establishing the obligation before services are rendered.

Claim filing requirements

Specific information needed in the first report to ensure compliance with state workers' compensation regulations.

Contributions to SSDI

Deductions taken from payroll under FICA to fund disability compensation.

Medical coding for workers’ compensation

Involves external cause codes to report the cause of injuries.

Exemptions for coverage under state plans

Categories of workers excluded from state workers' compensation coverage.