In the course of your workers' compensation claim, you will hear many terms tossed around without much explanation of the terms. Adjusters often use insurance industry jargon instead of taking the time to fully explain your rights. We have summarized much of that jargon below to help you understand it all.
TTD - Temporary Total Disability: This type of benefit is paid to you when your doctor indicates that you are totally unable to work. There are very specific ways to calculate the benefit based upon your employment, which we have addressed in an earlier blog post.
SEB - Supplemental Earnings Benefits: This type of benefit is paid to you once it is determined that you have work restrictions, but you are unable to earn at least 90% of your pre-accident wages.
COP - Choice of Physician: You have the right to select your own physician in each field or specialty. The insurance company will request that you sign this form choosing your physician before it will approve medical treatment.
SMO - Second Medical Opinion: Since you have your choice of physician, the insurance company can also send you to a doctor of its choosing. If proper notice is given and you fail to attend, then your benefits will be suspended.
IME - Independent Medical Examination: If your doctor and the insurance company's doctor (SMO) disagree regarding causation or work status, then either party may request a third doctor to issue an opinion. This doctor is selected by the Office of Workers' Compensation.
1020 (Employee's Monthly Report of Earnings): You are required by law to report any earnings from any source while receiving workers' compensation indemnity benefits (TTD or SEB).
1002 (Notice of Payment, Modification, Suspension, Termination or Controversion of Compensation or Medical Benefits): This notice must be sent to you by the adjuster indicating any initiation or change in your benefits.
FCE - Functional Capacity Evaluation: Your doctor may request this evaluation in order to more accurately determine your physical work ability (sedentary, light, medium, heavy).
1010 (Request for Medical Treatment): This form is submitted by the healthcare provider to the insurance company in order to determine whether the treatment should be approved, denied, or modified in accordance with the Medical Treatment Guidelines (or MTG).
1009 (Disputed Claim for Medical Treatment): If the 1010 is denied, then any aggrieved party, typically your doctor, may file this dispute with the Office of Workers' Compensation for a determination whether the treatment should be approved.
1008 (Disputed Claim for Compensation): This is a workers' compensation lawsuit which presents the disputed issues to a Judge for review.
The complex world of workers' compensation moves quickly which could require quick responses from you. If you need help, please call our office to schedule a consultation.
