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The Workers’ Compensation Act can sound a bit like a foreign language.
I want to help you understand some of the basic legal terms that are frequently used in connection with Workers’ Compensation Claims. What follows is a simplified listing of some of the commonly used terms, defined in plain English:
Accepted Claim:
This is a claim in which the Insurance company or the self-insured employer agrees that your injury or illness WILL be covered by Workers’ Compensation.
Average Weekly Wage (AWW):
This is the injured employee’s average weekly earnings prior to the injury. To determine the AWW, you find the average of the employee’s earnings during the 13-week period prior to the accident. If an employee was recently hired before he was injured or did not work a substantial number of 13 weeks before the injury, then the AWW of a similar employee is used instead. That person must be someone who is paid similarly, did the same type of work, and worked close to the same number of hours. Note of caution: The AWW can be complicated. It can be affected by many factors, such as if the employee had more than one job at the time of the injury, worked less than 13 weeks, or worked overtime. Employers and Insurance companies can make mistakes when calculating the AWW even if they try to get it right. It is always wise to have an experienced Workers’ Compensation lawyer look at the AWW numbers the employer or carrier calculates to make sure you are being compensated fairly and accurately.
Temporary Total Disability (TTD):
This is the rate at which wages are paid to the injured employee who is disabled from work per his treating physician. Weekly payments are two-thirds (66 2/3%) of the employee’s average weekly wage (AWW).
Denied Claim:
This is a claim in which the Insurance company or the employer does NOT accept or believe that they have a responsibility to provide compensation to the injured employee. This is NOT the end of the road. You can and should fight this denial if you were injured during the course and scope of your employment, even if the employer disagrees. Claims are filed and can be argued and tried before a judge with the Georgia Workers’ Compensation Board.
Maximal Medical Improvement (MMI):
This term is used to describe when the injured employee has reached a point where his or her condition will not change or improve, with or without more medical treatment. At MMI, the employee’s injuries are as good as they are going to get, and the doctors have done all they reasonably can. This status is determined by the authorized treating physician. Usually, at this point, the injured employee is “released” from the doctor’s care. An employee may want to consider settling his or her case when this happens. There are also times when an employee may want to settle his or her claim before MMI is reached. A skilled and experienced lawyer can advise you regarding this.
Medical Only Claim:
This term is typically used to describe a claim where the Employer or Insurance company accepts responsibility for the medical injury, treatment, and medical bills, but believe the injured employee is capable of working, so they are ONLY agreeing to pay for the medical treatment. You do NOT have to accept this decision if you feel you cannot return to work, and you should consult a lawyer immediately.
Modified or Light Duty Work:
This term describes the employment offered by an Employer to an injured employee while they are on restricted duty by the treating physician. This is often an area where disagreements occur between Employees and Employers. This is a situation where an employee may not feel he or she is being treated fairly. It is a good idea to talk to an experienced lawyer about this. In fact, having a lawyer before you are even released to light duty is often helpful because it can prevent problems and misunderstandings with the employer regarding light-duty work.
Permanent Partial Disability (PPD):
This is the percentage of disability measured by a doctor. It is based on a specific set of criteria that doctors use to calculate the percentage of permanent disability. The percentage results in payment to the injured worker of an additional benefit. The measurement is to a specific body part or parts. It will ultimately include the complete or partial loss of a part of the body or even the partial use of the body as a whole. It is wise to have a lawyer review this rating or provide information to a doctor to help calculate it. This will help to make sure that you are fairly compensated for a permanent injury and, if you settle your case, that the settlement reflects your true injuries and permanent limitations.
Temporary Partial Disability (TPD):
This term describes the compensation paid to the injured employee for the reduction in their earnings due to their injuries, if they are working on light duty restrictions, but working fewer hours or for less money than before their injury. It is two-thirds of the difference between the injured worker’s pre-injury wages and wages earned after the date of the injury.
Vocational Rehabilitation:
This term describes the educational and training benefits you may receive if you are permanently unable to do your usual job due to your work-related injury, and your employer cannot accommodate your permanent restrictions. It typically includes job placement retraining and assistance to help you obtain other employment during the time you are receiving benefits. Receiving these benefits may require the help of an attorney and complicated negotiations.
This is an excerpt of the book “11 Secrets to Winning Your Workers’ Compensation Claim.” This book will answer many of these questions and give you the knowledge you need. Get your free copy now.
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