Glossary

Able-bodied

Physically capable of doing a job.

Abstract

A summary of a document or record.

ACCES-VR (Adult Career and Continuing Education Services – Vocational Rehabilitation)

Assists individuals with disabilities to achieve and maintain employment and support independent living. One of the board approved organizations with which a workers’ compensation claimant can demonstrate attachment to the labor market.

Administrative Law Judge (ALJ)

An Administrative Law Judge is the presiding official at administrative hearings. They resolve disputes between a government agency and someone affected by the government agency’s decisions.

Administrative Order

An enforceable order issued by an ALJ at the end of an administrative proceeding.

Agreed Medical Evaluator

The doctor your attorney and the insurance company agree on to conduct the medical examination to help resolve your dispute.

Appeal

An application to a higher court for a decision to be reversed.

Appeal Hearing

A court session in which a claimant fights to have their initial verdict reversed or changed.

Appeals Council

Oversees the hearings and appeals process for the Social Security Administration. The appeals council is the last administrative decision level in the process before a claim appeal has to go to Federal Court.

Application for Benefits

The process of applying for Social Security benefits, Supplemental Security Income payments or Medicare where you must sign and complete an application.

Assessment

The act of appraising or evaluating.

Benefit Notice

A required letter or form sent by the insurance company to inform of benefits you may be entitled to receive.

Board Panel

A panel that reviews workers’ compensation cases in order to amend decisions made by workers’ compensation law judges, considers applications for lump sum non-schedule adjustment awards and reopens closed cases. Board panels usually consist of three board members, at least one must be a lawyer.

Civil Lawsuit

A legal dispute between two or more people or entities based on non-criminal statutes. In the case of a disability claim, a civil lawsuit is the last step of the claims appeal process. A civil action is filed and a Federal judge reviews the case in order to determine if the SSA was at fault in denying the claim.

Claim

A demand or request for something considered one’s due.

Claimant

The person making a claim.

Claimant Record of independent Job Search Efforts – Form C-258.1

Form used to show a claimants efforts to attach to the labor market. Records independent job search efforts and/or efforts made with the assistance from outside job placement services. Can be completed without completing Form c-258.

Claimant Record Of Job Search Efforts/Contacts – Form C-258

Form used to show a claimants efforts to attach to the labor market. Records independently conducted job search efforts.

Claims Adjustor

Insurance companies and others that handle your workers’ compensation claim.

Commutation

An order by a workers’ compensation judge for a lump sum payment of the permanent disability award.

Compassionate Allowances (CAL)

A program created by the SSA to speed up the disability claim process. Some, but not all, medical conditions are designated Compassionate Allowance. These serious and easily proven medical conditions can allow for fast approval of benefits claims based on a small amount of medical data.

Compliance

The function of ensuring that all employers required to do so carry workers’ compensation or disability benefits insurance coverage.

Concurrent Employment

Employment of one worker in more than one job during the same period.

Controverted Claim

When an insurance carrier or employer is disputing the validity of a claim. Benefits may not be received while a claim is controverted.

Cumulative Injury

An injury that was caused by repeated exposures or events at work.

Death Benefits

Benefits received by survivors of workers who have died from a work-related injury or illness. Often determined through the earnings of the deceased and the number of dependents eligible for benefits.

Declaration Of Readiness

When you’re ready to resolve a dispute, this is the form used to request a hearing before a workers’ compensation judge.

Degree of Disability

A percentage given to an injury which determines the severity of an injury and the percentage of wage to be received until permanent loss of wage earning capacity is determined.

Dire Need Cases

When a disability claimant does not have the resources to get food, medicine or shelter, the case may be treated as a critical case by the SSA. Adequate evidence of the claimant being in dire need of their ‘basic needs’ will be necessary for qualification.

Disability Determination Services (DDS)

State agencies, funded by the United States Federal Government. Their purpose is to make disability findings for the Social Security Administration (SSA).

Disability Examiner

A specialist who works at a state agency whose function is to evaluate disability claims (both social security disability and SSI disability for the social security administration). These state agencies are disability determination services.

Disability Insurance

A form of insurance that insures the beneficiary’s earned income against the risk that a disability can create a wall for an employee that keeps them from completing the main functions of their job.

Disabled

The Social Security Administration considers you disabled under Social Security rules if you meet all three of these criteria:

• You cannot do work that you did before.
• You cannot adjust to other work because of your medical condition(s).
• Your disability has lasted or is expected to last for at least one year or to result in death.

Drug Formulary

A list of generic and brand name prescription drugs used by practitioners to identify drugs offering the greatest overall value. A Drug Formulary is maintained by a committee of physicians, nurse practitioners and pharmacists.

Emotional Distress

A basis for a claim of damages in lawsuits for injury due to the negligence.

Employer Number

A unique employer identification number assigned by the Board. This number is generated by the Insurance Compliance system for each employer on record at the Board. It is stored in the Common Employer Database, for use by both Workers’ Compensation and Disability Benefits. The Employer Number is the primary identifier for all employer records and documents, and is the preferred means of searching for employer records.

Exclusiveness of Remedy

Refers to the workers’ compensation system’s status as the exclusive remedy of an employee against her/his insured or lawfully self-insured employer. The system is the sole recourse that the employee, and/or her/his dependents or representatives have against such employers for injuries or death resulting from a work-connected accident or occupational disease.

Extreme Hardship Determination Threshold

A determination made within capped Permanent Partial Disability claims where claimants are found to have a Loss of Wage earning Capacity (LWEC) exceeding 75

Federal Employer Identification Number (FEIN)

A nine-digit tax identification number assigned by the IRS for all employers other than sole proprietors. (A sole proprietor uses his social security number [SSN] as his business’s tax identification number.)

Freedom of Information Act (Law)

The Federal law concerned with ensuring public access to federal government records, with limited statutory exceptions. The New York State version (Public Officers Law, Article 6 – commonly referred to as the Freedom of Information Law or FOIL) requires all state and local government agencies to provide public access to all of their records, with limited exceptions. The Board has taken the position that claim information is not subject to FOIL as excepted based on personal privacy considerations.

Future Earning Capacity

A multiplier that increases the disability rating based on how much wage loss a type of injury causes on average when compared to other types of injuries.

Hearing

The Workers’ Compensation Law provides that no case may be closed without notice to all parties interested, with all such parties having an opportunity to be heard. The Workers’ Compensation formal “hearings” are held before Workers’ Compensation Law Judges who hear and determine claims for compensation, for the purpose of ascertaining the rights of the parties.

Impairment Rating Evaluation

Also known as a Permanent Disability Rating, an IRE is a medical examination which assesses the severity of a permanent impairment resulting from workers’ compensation injuries.

Incurred Losses

Indemnity and medical losses that are recognized by a carrier at a particular valuation date, including (a) payments already made, (b) reserves for future payments, (c) estimated present value of future payments, if applicable and (d) deductions for benefit offsets, subrogation or other deductions from losses, if applicable.

Independent Medical Examination (IME)

A medical examination evaluating mental or physical injury which is performed by a doctor who was not previously involved in a claimant’s medical care. Independent medical examinations are often ordered by workers’ compensation carriers when disputing a workers compensation claim but can also be ordered by the court.

Initial Claim

The first time a claimant submits their request for something considered their due.

Judgment

Court order obligating a debtor to pay. The Workers’ Compensation Board obtains judgments against employers that fail to pay penalties.

Labor Market Attachment

In regard to Workers’ Compensation, labor market attachment is the proof necessary to show that you are taking the steps to find employment which lies within your physical limitations.

Legal Consultation

A session in which a claimant meets with a lawyer for advice.

Licensed Representative

(a) Any person other than an attorney who is authorized by the Workers’ Compensation Board to represent claimants before the Board and, in some instances, to receive a fee, fixed by the Board, for such services; also (b) Any person other than an attorney who is authorized by the Workers’ Compensation Board to represent self-insureds before the Board.

Loss of Wage Earning Capacity (LWEC)

A Workers’ Compensation Standard used to evaluate non-schedule permanent impairments and to determine the amount and duration of lost income benefits to be received.

Maximum Medical Improvement (MMI)

A level an injured employee reaches in which no medical improvement can be expected by continuing medical or rehabilitative procedures.

New York Compensation Insurance Rating Board

A private, non-profit association of licensed insurance companies that provide workers’ compensation insurance in New York. The organization is responsible for, among other things, collecting and reviewing compensation loss experience from carriers, developing policy forms and rating plans, conducting actuarial analyses, and preparing rate filings with the (New York State) Insurance Department.

New York State AFL-CIO

A federation of 3,000 affiliated public sector, private sector and building trades unions throughout New York State. The federation is committed to the fight for social and economic justice by working with their affiliates, area labor federations, central labor councils and community allies.

New York Workers’ Compensation Alliance (WCA)

A statewide coalition of injured workers and other stakeholders committed to protecting the rights of injured workers under the NYS Workers’ Compensation Law.

Non-Schedule Awards

A workers compensation award given to those who have permanent disability involving a body part or condition not covered by a SLU award (e.g. brain, heard, spine, pelvis, lungs, etc.). Non-schedule awards are based on permanent loss of wage earning capacity.

Occupational Illness

Any condition or disorder (includes acute and chronic illnesses or diseases) resulting from exposure to environmental factors associated with the work environment. These can be caused by absorption, ingestion, or direct contact or inhalation.

Occupational Injury

Any injury (sprain, fracture, amputation, etc.) resulting from a work accident or exposure in the work environment.

Office of Disability Adjudication and Review (ODAR)

Responsible for holding hearings, issuing decisions, and reviewing appeals as part of the Social Security Administration’s process for determining whether a person may receive benefits.

Permanent Partial Disability

Workers who have reached maximum medical recovery and remain with permanent impairments but retain limited ability to work. These types of benefits are often limited to a specific duration or aggregate dollar amount.

Permanent Total Disability

Workers who have reached maximum medical recovery but are still deemed to have significant impairments which prohibit them from performing the work they were doing prior to injury. These workers receive permanent total disability benefits. Very few claims result in permanent total disability.

Public Comment Period

The time in which the Workers’ Compensation Board accepts comments from the public on proposed actions and decisions. In the case of workers’ compensation reform this period of time allows the public to participate in the administrative decision making process regarding proposed reform to workers’ compensation law.

Qualified Injured Worker (QIW)

Injured worker who will most likely never be able to return to their prior job and working conditions but will likely be able to find a suitable job after receiving vocational rehabilitation.

Qualify

To demonstrate the proper knowledge, documentation and by fulfilling proper conditions in a matter.

Quick Disability Determination (QDD)

A method the SSA uses to process SSI and SSDI claims quickly. Through a predictive computer modeling program, electronic files are analyzed to determine if there is a high probability that a disability benefits applicant will be found disabled.

Regulations

A rule or law prescribed by authority, especially how it pertains to conduct.

Schedule Loss of Use (SLU) Awards

A workers compensation award given to those who have permanent injury to specific body parts (e.g. hands, arms, feet, legs or hearing or eyesight). SLU awards are an additional cash payment given if the level of use of an injured body part is not the same after maximum medical improvement is achieved. Awards are limited to a specified number of weeks based on the specific body part and degree of disability.

Social Security Administration

An agency of the United States federal government that administers Social Security (social insurance program that consists of retirement, disability, and survivors’ benefits).

Social Security Administration (SSA)

An independent agency of the United States Federal Government who administers Social Security, a social insurance program consisting of retirement, disability and survivors benefits.

Social Security Denial

Notification presented to such agencies to prove your ineligibility for a SSN and support that your ineligibility should not restrict you from obtaining such services.

Social Security Disability (SSD)

Social Security Disability is a total disability program, not a short-term or temporary disability program for individuals.

Social Security Lawyer

An attorney that specifically deals with Social Security and Disability cases.

SSD Payments

The amount you receive each month will be based on your average lifetime earnings before your disability began.

Supplemental Security Income (SSI)

Supplemental Security Income is a United States government program. The program provides stipends to people of low-income who are either 65 or older, blind, or otherwise disabled. SSI is funded from the U.S. Treasury general funds, not the Social Security trust fund. Terminal Illness Cases (TERI) or TERI Program

Temporary Partial Disability

Workers who are able to return to work before reaching maximum medical recovery. These workers return with less responsibilities and decreased salary. Temporary partial disability benefits are received in these cases.

Temporary Total Disability

Workers who are temporarily unable to perform their job or another job for their employer that they would have been able to perform before injury. Most of these workers recover fully and are able to return to work. At that time, the distribution of benefits end.

Total Industrial Disability

Claimants who have a partial disability but are unable to work due to additional factors such as age, education, job skills, etc. may be classified with total industrial disability allowing them the ability to receive lifetime benefits like that of someone classified with a permanent total disability.

Vocational Expert (VE)

An “expert witness” called by the SSA to testify at disability hearings.

Vocational Rehabilitation Maintenance Allowance Benefits (VRMA)

Allowance benefits paid to an injured worker who is participating in vocational rehabilitation.

Wage Expectancy

Used when deciding weekly wage for a young claimant whose wage would have been expected to increase under normal conditions. The wage rate determined is an artificial rate and is given to claimants under the age of 25 (at the time of injury).

Wage Replacement

The amount of pre-injury wages replaced by workers’ compensation benefits.

Waiving

To refrain from insisting on or using a right or claim.

Workers’ Compensation

A form of insurance and protection that provides wage/pay replacement and medical benefits to those employees who are injured during the course of their employment, in exchange for a mandatory surrender of the employee’s right to sue his/her employer for negligence.

Workers’ Compensation Board

A government agency that actively reviews disputes arising under the worker’s compensation statutes. The functions of board include:

• settle disputes relating to right to and the amount of compensation;
• supervise voluntary settlements or agreements;
• collect and administer compensation funds;
• supervise and regulate matters relating to compensation insurance.