Navigating the world of workers’ compensation can be challenging, especially when confronted with a sea of legal jargon. To help you better understand this complex field, we’ve compiled a comprehensive list of common workers’ compensation terms you need to know. Whether you’re a worker seeking benefits, or an employer handling claims, this guide will demystify the terminology and provide clarity on the essentials.
Workers’ Compensation
Workers’ compensation is a state-mandated insurance program that provides medical and wage loss benefits to employees who are injured on the job. It offers financial support and medical coverage to injured workers, regardless of fault. This system ensures that employees receive compensation for workplace injuries without the need for litigation.
Claimant
The injured worker who is seeking workers’ compensation benefits is referred to as the claimant. This individual is the party making the claim for compensation. Claimants file claims to request benefits after a workplace injury, such as medical expenses and wage replacement.
Employer of Record
The employer where the injury occurred is known as the “employer of record.” This is the entity responsible for providing workers’ compensation benefits to the injured employee. The employer of record may be the direct employer or a client company for workers employed by a staffing agency.
Medical-Only Claim
In some cases, injuries may only require medical treatment without time off work. A medical-only claim covers the cost of medical expenses without wage loss benefits. These claims are common for minor injuries that do not result in lost workdays.
Temporary Total Disability (TTD)
TTD benefits are provided to injured workers who are temporarily unable to work due to their injuries. These benefits replace a portion of the worker’s lost wages until they can return to work. TTD benefits are typically calculated as a percentage of the worker’s pre-injury wages.
Permanent Partial Disability (PPD)
When an injured worker reaches maximum medical improvement but has a permanent impairment, they may be eligible for PPD benefits. These benefits compensate the worker for the lasting effects of their injury, such as reduced earning capacity. PPD benefits are typically determined based on medical evaluations and specific statutory guidelines.
Permanent Total Disability (PTD)
PTD benefits are awarded to workers who are permanently unable to return to any gainful employment due to their work-related injury. These benefits provide ongoing financial support to individuals whose injuries result in complete and permanent disability. PTD benefits vary by state and may continue for the worker’s lifetime.
Independent Medical Examination (IME)
An IME is a medical evaluation conducted by a healthcare provider chosen by the workers’ compensation insurance company. It aims to assess the extent of the injury and the worker’s ability to return to work. IMEs are often used to resolve disputes and determine the appropriate level of benefits.
Vocational Rehabilitation
When an injured worker cannot return to their previous job due to a disability, vocational rehabilitation provides training and support to help them re-enter the workforce in a different capacity. Vocational rehabilitation services can include job retraining, job placement assistance, and counseling.
Third-Party Claim
In some cases, a third party, such as the manufacturer of faulty equipment, may be partially responsible for a workplace injury. In such situations, the injured worker may pursue a separate legal claim against this third party in addition to their workers’ compensation claim. A successful third-party claim can result in additional compensation for the injured worker.
Statute of Limitations
Workers’ compensation claims must be filed within a specified time frame, known as the statute of limitations. This period varies by state and typically begins on the date of the injury or the date when the worker became aware of the injury. It is crucial to adhere to these deadlines, as filing a claim outside the statute of limitations may result in the denial of benefits.
Denial of Claim
If an insurance company disputes a workers’ compensation claim, the claim is said to be denied. Claim denials may be appealed through a legal process. Workers can challenge claim denials by providing additional evidence or through legal proceedings, such as a hearing before an administrative law judge.
Choose Erwin, McCane & Daly
Navigating the workers’ compensation system in New York State can be complex, but understanding your rights and responsibilities is essential. If you suffer a workplace injury, take the necessary steps to report the incident and file a claim promptly. Seeking legal guidance from an experienced workers’ compensation attorney can also be invaluable in ensuring you receive the benefits you deserve. Your health and financial stability are at stake, so it’s essential to be well-informed and prepared when dealing with workers’ compensation in New York State. With the right knowledge and support, you can navigate the system effectively and secure the benefits you need for your recovery. Our team offers free consultations and represents our claimants for no upfront cost. When we are successful in your claim, the judge will determine what our fee should be. Visit our website to learn more or to contact our team today!
