HELPLINE | 888.788.NAIDW(6243) Sign up for email updates Tooltip youtube Google + Pinterest linkedin

Vinaora Nivo SliderVinaora Nivo SliderVinaora Nivo SliderVinaora Nivo SliderVinaora Nivo SliderVinaora Nivo SliderVinaora Nivo SliderVinaora Nivo Slider
NAIDW ABOUT US

NAIDW ABOUT US (75)

Thursday, 30 September 2010 09:39

State Chapters | NAIDW

Written by

NAIDW is seeking natural leaders, self-starters, highly competent, creative and talented professional people to help run our State Chapters.

State Chapters

National Association of Injured & Disabled Workers nationwide network of chartered State Chapters provide direct information, resources, support, education and advocacy for injured & disabled workers and their families suffering from the results of injury, illness, pain, disability or death. Theiy are friends, families, and professionals who provide research, treatment and services to the general public and NAIDW members.

To find a chartered state chapter and resources near you, click on a state in the map below.

 

Canada

Canada

International

 World Map

 

 


 

Thursday, 30 September 2010 09:09

Get Started | NAIDW

Written by

Get Started

 

Here's how to use NAIDW.org to HELP find the information, resources, and support you need for your injury, illness, pain or disability.

Start the steps to reclaim your life!

 

check-box

NAIDW Chat Nights – Every Monday, Wednesday, Friday and Saturday night 10:00 to 12:00 PM Eastern Standard Time!

check-box

NAIDW Day Chat – Every Tuesday and Thursday 1:00 to 3:00 PM Eastern Standard Time!

check-box

NAIDW Life Coaching - Every Wednesday at 1:00 to 1:30 PM Eastern Standard Time. The purpose of this discussion is for members to create an agenda based on topics that are relevant and useful now!

check-box

Resource Center for links to Local, State, Federal Government and International Departments.

check-box

Directory of Personal Injury, Workers' Compensation & Social Security Disability Attorneys, Doctors, and much more!

check-box

Get Financial Assistance through grants made available through NAIDW.

check-box

Get answers to Frequently Asked Questions.

check-box

Search the Glossary to find the meaning behind commonly used terms

check-box

Stay up to date with news about Injured Workers, Social Security Disability, and Workers' Compensation, Disability and much more!

check-box

The most comprehensive online directory for Injured & Disabled Workers! - We work with all of our sponsors in order for you to receive a mimimum of 20% in discounts for their services. Please make sure to mention NAIDW.



Getting Started Work Injuries

If you have been injured, follow these steps carefully!

  1. Contact your employer immediately! (If Work Related)
  2. Seek medical attention, even if you don’t think you are injured.
  3. Follow up with doctors and specialists. Don’t be afraid to ask questions. Remember that they are there to help you. Understanding your injury is vitally important.
  4. Get a second opinion. We are programmed not to question the opinion of doctors. However, a second opinion can make the difference between life and death.
  5. Seek legal counsel. Remember to always ask questions and get the information you need to be an active participant in your case. It is always important to assert yourself and be aware of the process.
  6. STOP spending and start saving. I say this with an extreme emphasis and I understand the difficulty. You have worked long and hard for your current lifestyle and giving it up seems out of the question. In the beginning, it will probably feel like things will remain the same, especially when you are being financially compensated. Yet the harsh reality is that the insurance company can terminate your benefits at any point. It’s important that you are prepared for them to do so because your medical and monetary benefits can be gone when you least expect it.
  7. Apply for Social Security Disability. Take this action if you believe that you will be out of work for more than one continuous year. This determination is only made by you and your doctor. However, it’s important you recognize that applying for Social Security Disability is a long and tedious process, and it’s always best to get a head start.
  8. Start talking to people. Friends and family will become vitally important. This is a very lonely process in which you need to stay mentally sharp and uncluttered. However, never discuss specific details about your case with anyone other than to your attorney, doctors, and immediate family.
  9. Seek mental health care if needed. Again, you need to keep thinking positive and moving forward.
  10. Stay strong, stay focused, don’t stand down, and do not allow yourself be taken advantage of—ever!
     

Getting Started With illness

If you have a chronic illness, follow these steps carefully!

Illnesses and Pain can range from Reflex Sympathetic Dystrophy to diabetes, multiple sclerosis and fibromyalgia, and painful conditions like back pain and migraines.

 


Getting Started With Pain

 

If you have a pain disorder, follow these steps carefully!

Illnesses and Pain can range from Reflex Sympathetic Dystrophy to diabetes, multiple sclerosis and fibromyalgia, and painful conditions like back pain and migraines.

 


Getting Started With Disability

 

If you have a disability, follow these steps carefully!

 

 


Getting Started Veterans Benefits

 

 

 


Financial Stability "7 Steps to Financial Stability for Injured & Disabled Workers"

 

1. Knowing for sure it’s possible! Understand that you can be financially stable if it's a priority for you (and it should be). Realize that any roadblocks you have about money are correctable. Others have done it and so can you.

2. Re-orient your thinking around becoming financially stable! This might require you to make substantial changes like cutting expenses by 25-40% and using the extra money tocreate a nest egg to sustain you until you are healthy. Invest in your own skills training in order toincrease your earnings. Make the emotional and self-worth shifts that are required to experience abundance.

3. Get yourself fully informed about the topic of finances! Read a book or find a financial planner who will help you understand your taxes, what compounding interest is, what good investments are, how much you’ll need when you retire etc. Start hanging around people you like who already have money and learn from them. You don’t have to reinvent the wheel here folks.

4. Create income where non existed! Increase fees, decrease expenses, be more productive, or find a new career entirely. Get into a field that offers opportunity, demand and growth (and pays well). Now might be the perfect time to pursue your dream job.

5. Build a cash base! There is a psychological feeling of security that comes with having more than you need. Create a plan to achieve this within 10 years, or sooner. Be realistic yet aggressive. Properly set up structures, supports and follow through will make having a cash reserve possible.

6. Protect what you have! Get plenty of insurance: medical, life, disability, homeowners/renters, business, and liability. Invest in very safe investments; no more than 10% in speculative investments. Remember, that without the “fear of loss”you’ll move forward naturally.

7. Start living well and include rewarding yourself periodically!

You don't have to wait to start enjoying your financial independence efforts; reward yourself now and again to keep it fun and stay motivated. In the meanwhile, spend money on truly valuable things like fresh food, a good quality mattress, clothingthat fits and makes you look your best.

Thursday, 30 September 2010 08:17

Become A Volunteer | NAIDW

Written by

Volunteer Application


Join Our Team

Since the first NAIDW team member joined us in the summer of 2009, NAIDW has been committed to hiring the most incredible people. What we’re building here is as much about creating a great team as it is about creating a great foundation. By finding the right people, who share our values and our vision, we can proudly say that we move closer to our goals every day.

NAIDW is actively seeking like minded individuals to join our staff. If you are interested in becoming a part of the "Soon To Be Famous" largest advocacy group for injured & disabled workers we would love to hear from you! Please fill out this form and we will get in touch with you shortly with available opportunities.

NAIDW counts on the support of our volunteers to achieve our mission. We are currently in need of volunteers in all areas of our organization. Please contact us toll-free if you are interested in volunteering your services at (888) 788-NAIDW


NAIDW is seeking all natural leaders, all self-starters, all highly competent, creative and talented professional people for all positions.
Currently seeking: (All Positions Can Be Virtual!)
  • Communications Director - Social Media Administrators
  • Director of Operations (DOP) National
  • Spokesperson Executive Assistant - (Virtual)
  • Office Managers
  • Volunteer Coordinator
  • Content & Blog Editor
  • Joomla & Programing (website support)
  • State Chapter Directors, Representatives & Administrators
  • Content Manager/Research & Development, Resource Development Canadian Affairs Director
  • Blog Contributers
  • Freelance Writers
  • Grant Writers
  • Partner Development - Sales
  • Patient/Victim Specialists
  • Chat Room & Forum Moderators
  • Audio Video Producer/Engineer & Host
  • General Volunteer HELP

If you are interested in joining our team please visit our career center and fill out an online application.

Join Our Team

NAIDW is actively seeking like minded individuals to join our staff. If you are interested in becoming a part of the "Soon To Be Famous" largest advocacy group for injured & disabled workers we would love to hear from you! Please fill out this form and we will get in touch with you shortly with available opportunities.


Full Name (*)

Please type your full name.
Street Address (*)

Invalid Input
City (*)

Invalid Input
State (*)

Invalid Input
Zip Code (*)

Invalid Input
Phone Number (*)

Invalid Input
E-mail (*)

Invalid email address.
Areas of Interest (*)

Invalid Input
Additional Info (*)

Invalid Input
ANTI-SPAM (*)
ANTI-SPAM
  Refresh
Invalid Input

  

Confidentiality Agreement: As a volunteer you may be exposed to or in the possession of confidential information, i.e.; contact information, health information of injured & disabled workers, members, partners, sponsors, etc. By your signature below you agree that this information must be held in the strictest of confidence and may only be used for the sole purpose of NAIDW activities and projects. Any unauthorized use may constitute a violation of state or federal laws.
Thursday, 30 September 2010 08:13

Available Grants | NAIDW

Written by

NAIDW Grants Programs

INFORMATION & QUALIFICATIONS FOR APPLICANTS


NAIDW is a nationally recognized 501 (c) (3) public charity whose purpose is to provide unlimited resources, support, guidance and short-term financial assistance to injured & disabled workers and their families as a result of injury, illness, pain or disability. Applications for assistance must be received by June 30th and December 31st to qualify. Decisions are then made for assistance. Such assistance is given through the Grants Program and is provided on a one time basis, per calender year. Applicants may apply twice a year.

Our Grants Committee reviews applications and selects award recipients semi annually. Within six months of your submission, we will notify you by email about the status of your application. Because of the high level of interest in our program, we're not able to respond to requests for information about the status of individual applications.

In the meantime, learn about more free products NAIDW offers to our members. To find more resources visit our Resource Center page and Member Privileges. We appreciate your patience as we review your NAIDW Grants application.

You can also create a free crowdfunding campaign for immediate assistance from our members and visitors. Unlike other crowdfunding platforms NAIDW does not charge and fee or percentage, its all FREE and the money goes directly to your bank account via PayPal. Read more here about the NAIDWfundMe app and create your campaign here.

Sincerely,
The NAIDW Grants Team

 


 

All grants are paid directly to provider or debtors. Please note that no goods or services should be provided in exchange of these grants.

Please remember that we are limited to what we can do depending on our funding! We will always try to do everything we can to HELP each and every injured & disabled worker. PLEASE DO NOT CALL REQUESTING AID! YOU MUST FIRST BECOME A MEMBER AND FILL OUT GRANT APPLICATION!
 

NAIDW KidsCare® Program: Continued Child Education

NAIDW will provide grants to the children of Injured & Disabled workers for the continuation of their college/trade-school educational needs. This includes but is not limited to: Tuition, Room/Board, Books etc...

 


NAIDW FallenWorkers.org® Program:

NAIDW will provide grants to the Injured & Disabled workers and thier familiesfor assistance with burial needs and arrangements.

 


 

Program: Housing

NAIDW will provide grant based assistance for all housing needs of Injured & Disabled workers. This includes, but is not limited to: Mortgage, Rent, Food, and Utilities etc...

 


 

Program Medical

NAIDW will provide grant based funding to help cover the cost of necessary medical expenses for Injured & Disabled workers. This includes, but is not limited to: Surgeries, Medical Bills, Prescription Drugs, etc...

 


 

Program - PFFA

NAIDW will provide assistance for our members requiring assistance in travel related hardships of our members to get them and their family to required and necessary medical treatments. Known as "PFMAP" Patient & Family Medical Assistant Program. NOTE: This program is still very new and we are working on finding and implimenting the resources necessary to execute this huge endevour. Please be patient. Click Here To Apply For a Grant

 


What does the Foundation do?

The National Association of Injured & Disabled Workers Foundation is a 501(c)(3) non-profit charity dedicated to facilitating access to medical-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the injured & disabled workers and that are not fully covered by the available commercial health benefit plan. This “support” is in the form of a medical grant to be used for medical services not covered or not completely covered by commercial health benefit plans. Some frequently asked questions are located here.

What are the grants?

In order to learn more about the grants, please tell us who you are:

Tuesday, 21 September 2010 23:08

Glossary of Terms

Written by

The information contained in this fact sheet is general in nature and is not intended as a substitute for legal-medical advice. Changes in the law or the specific facts of your case may result in legal interpretations different than those presented here.

Accepted claim: A claim in which the insurance company agrees your injury or illness is covered by workers’ compensation. Even if your claim is accepted there may be delays or other problems. Also called admitted claim.

ACOEM: American College of Occupational and Environmental Medicine. Until the state Division of Workers’ Compensation (DWC) adopts medical treatment guidelines, the guidelines published by ACOEM, called “Occupational Medicine Practice Guidelines,” are the guidelines used in most cases to decide the type and amount of treatment you’ll receive for a work injury or illness.

Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. If you don’t have an attorney, you will use a qualified medical evaluator (QME). See QME.

Alternative work: A new job with your former employer. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured, and be within a reasonable commuting distance of where you lived at the time of injury.

American Medical Association (AMA): A national physician’s group. The AMA publishes a set of guidelines called “Guides to the Evaluation of Permanent Impairment.” If your permanent disability is rated under the 2005 rating schedule, the doctor is required to determine your level of impairment using the AMA’s guides.

Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. If you believe you’ve been discriminated against at work because you’re disabled and want information on your rights under the ADA, contact a U.S. Equal Employment Opportunity Commission office. For the EEOC office in your area, call 1-800-669-4000 or 1-800-669-6820 (TTY).

AOE/COE (Arising out of and occurring in the course of employment): Your injury must be caused by and happen on the job.

Applicant: The party — usually you — that opens a case at the local Workers’ Compensation Appeals Board (WCAB) office by filing an application for adjudication of claim.

Appeals board: A group of seven commissioners appointed by the governor to review and reconsider decisions of workers’ compensation administrative law judges. Also called the Reconsideration Unit. See Workers’ Compensation Appeals Board.

Applicants’ attorney: A lawyer that can represent you in your workers’ compensation case. Applicant refers to you, the injured worker.

Application for adjudication of claim (application or app): A form you file to open a case at the local Workers’ Compensation Appeals Board (WCAB) office if you have a disagreement with the insurance company about your claim.

Apportionment: A way of figuring out how much of your permanent disability is due to your work injury and how much is due to other disabilities.

Audit Unit: A unit within the DWC that receives complaints against claims administrators. These complaints may lead to investigations of the way the company handles claims.Benefit notice: A required letter or form sent to you by the insurance company to inform you of benefits you may be entitled to receive. Also called notice.

Cal/OSHA: A unit within the state Division of Occupational Safety and Health (DOSH). Cal/OSHA inspects workplaces and enforces laws to protect the health and safety of workers in California.

California Labor Code section 132a: A workers’ compensation law that prohibits discrimination against you because you filed a workers’ compensation claim, and against co-workers who might testify in your case.

Carve-out: Carve-out programs allow employers and unions to create their own alternatives for workers’ compensation benefit delivery and dispute resolution under a collective bargaining agreement.

Claim form: The form used to report a work injury or illness to your employer. Claims adjuster: See claims administrator.

Claims administrator: The term for insurance companies and others that handle your workers’ compensation claim. Most claims administrators work for insurance companies or third party administrators handling claims for employers. Some claims administrators work directly for large employers that handle their own claims. Also called claims examiner or claims adjuster.

Claims examiner: See claims administrator.

Commission on Health and Safety and Workers’ Compensation (CHSWC): A state-appointed body that conducts studies and makes recommendations to improve the California workers’ compensation and workplace health and safety systems.

Commutation: An order by a workers’ compensation judge for a lump sum payment of part or all of your permanent disability award.

Compromise and release (C&R): A type of settlement in which you receive a lump sum payment and become responsible for paying for your future medical care. A settlement like this must be approved by a workers’ compensation judge.

Cumulative injury (CT): An injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over or losing your hearing because of constant loud noise.

Date of injury: When you got hurt or ill. If your injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated exposures (a cumulative injury), the date of injury is the date you knew or should have known the injury was caused by work.

Death benefits: Benefits paid to surviving dependents when a work injury or illness results in death. Declaration of readiness (DOR or DR): A form used to request a hearing before a workers’

compensation judge when you’re ready to resolve a dispute.

Defendant: The party –- usually your employer or its insurance company — opposing you in a dispute over benefits or services.

Delay letter: A letter sent to you by the insurance company that explains why payments are delayed. The letter also tells you what information is needed before payments will be sent and when a decision will be made about the payments.

Denied claim: A claim in which the insurance company believes your injury or illness is not covered by workers’ compensation and has notified you of the decision.

Description of employee’s job duties (RU-91): A form filled out jointly by you and the insurance company that helps your treating physician decide whether you will be able to return to your normal job and working conditions.

Determination and order (D&O): A decision by the DWC Rehabilitation Unit on a vocational rehabilitation dispute.

Disability: A physical or mental impairment that limits your life activities. A condition that makes engaging in physical, social and work activities difficult.

Disability Evaluation Unit (DEU): A unit within the DWC that calculates the percent of permanent disability based on medical reports. See disability rater.

Disability management: A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment. This is done early in the recovery process in severe injury cases such as spinal injuries. Usually a rehabilitation nurse is involved with you and your treating doctor and the progress of your medical treatment is reported to the insurance company.

Disability rater: An employee of the DWC Disability Evaluation Unit who rates your permanent disability after reviewing a medical report or a medical-legal report describing your condition.

Disability rating: See permanent disability rating. Discrimination claim (Labor Code132a): A petition filed if your employer has fired or otherwise

discriminated against you for filing a workers’ compensation claim.

Dispute: A disagreement about your right to payments, services or other benefits.

Division of Workers’ Compensation (DWC): A division within the state Department of Industrial Relations (DIR). The DWC administers workers’ compensation laws, resolves disputes over workers’ compensation benefits and provides information and assistance to injured workers and others about the workers’ compensation system.

Electronic Adjudication Management System (EAMS): A computer based system to simplify and improve the Division of Workers’ Compensation case management process.

Employee: A person whose work activities are under the control of an individual or entity. The term employee includes undocumented workers and minors.

Employer: The person or entity with control over your work activities.

Ergonomics: The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work. That means considering the variability in human capabilities when selecting, designing or modifying equipment, tools, work tasks and the work environment.

Essential functions: Duties considered crucial to the job you want or have. When being considered for alternative work, you must have both the physical and mental qualifications to fulfill the job’s essential functions.

Fair Employment and Housing Act (FEHA): A state law that prohibits discrimination against people with disabilities. If you believe you’ve been discriminated against at work because you’re disabled and want more information on your rights under the FEHA, contact the state Department of Fair Employment and Housing at 1-800-884-1684. In some cases, the FEHA provides more protection than the federal Americans with Disabilities Act (ADA).

Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid,

job-protected leave per year. It also requires that group health benefits be maintained during the leave. For more information, contact the U.S. Department of Labor at 1-866-4-USA-DOL.

Filing: Sending or delivering a document to an employer or a government agency as part of a legal process. The date of filing is the date the document is received.

Final order: Any order, decision or award made by a workers’ compensation judge that has not been appealed in a timely way.

Findings & award (F&A): A written decision by a workers’ compensation administrative law judge about your case, including payments and future care that must be provided to you. The F&A becomes a final order unless appealed.

Fraud: Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers’ compensation benefits. The penalties for committing fraud are fines up to $150,000 and/or imprisonment for up to five years.

Future medical: On-going right to medical treatment for a work-related injury. Health care organization (HCO): An organization certified by the Department of Industrial Relations to

provide managed medical care within the workers’ compensation system.

Hearings: Legal proceedings in which a workers’ compensation judge discusses the issues in a case or receives information in order to make a decision about a dispute or a proposed settlement.

In pro per: An injured worker not represented by an attorney.

Independent contractor: There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor. Some employers misclassify employees as an independent contractor to avoid workers’ compensation and other payroll responsibilities. Just because an employer says you are an independent contractor and doesn’t need to cover you under a workers’ compensation policy doesn’t make it true. A true independent contractor has control over how their work is done. You probably are not an independent contractor when the person paying you:

? Controls the details or manner of your work ? Has the right to terminate you ? Pays you an hourly wage or salary ? Makes deductions for unemployment or Social Security ? Supplies materials or tools

? Requires you to work specific days or hours Industrial Medical Council (IMC): No longer in existence. See Medical Unit.

Information & Assistance Unit (I&A): A unit within DWC that provides information to all parties in workers’ compensation claims and informally resolves disputes.

Information & Assistance (I&A) officer: A DWC employee who answers questions, assists injured workers, provides written materials, conducts informational workshops and holds meetings to informally resolve problems with claims.

Injury and illness prevention program (IIPP): A health and safety program employers are required to develop and implement. This program is enforced by Cal/OSHA.

Impairment rating: A percentage estimate of how much normal use of your injured body parts you’ve lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate your permanent disability rating but is different from your permanent disability rating.

Judge: See workers’ compensation administrative law judge.

Lien: A right or claim for payment against a workers’ compensation case. A lien claimant, such as a medical provider, can file a form with the local Workers’ Compensation Appeals Board to request payment of money owed in a workers’ compensation case.

Mandatory settlement conference (MSC): A required conference to discuss settlement prior to a trial.

Maximal medical improvement (MMI): Your condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Once you reach MMI, a doctor can assess how much, if any, permanent disability resulted from your work injury.

Mediation conference: A voluntary conference held before an I&A officer to resolve a dispute if you are not represented by an attorney.

Medical care: See medical treatment. Medical-legal report: A report written by a doctor that describes your medical condition. These reports

are written to help clarify disputed medical issues.

Medical provider network (MPN): An entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC’s administrative director to treat workers injured on the job.

Medical treatment: Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care.

Medical Unit: A unit within the DWC that oversees medical provider networks (MPNs), independent medical review (IMR) physicians, health care organizations (HCOs), qualified medical evaluators (QMEs), panel QMEs, utilization review (UR) plans, and spinal surgery second opinion physicians. Formerly called the Industrial Medical Council (IMC).

Medicare Set-Aside (MS): After a person is eligible for Medicare. Medicare, is demanding that these funds be set aside in trust for the future medical expenses during years of Medicare eligibility.

Modified work: Your old job, with some changes that allow you do to it. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you modified work instead of supplemental job displacement benefits or vocational rehabilitation benefits.

Nontransferable voucher: A document you get from the insurance company that must be completed by both you and the insurance company. This is the document used to provide payment for education under the supplemental job displacement benefit program.

Notice: See benefit notice. Objective factors: Measurements, direct observations and test results a treating physician, QME or an

AME says contribute to your permanent disability.

Off calendar (OTOC): A WCAB case in which there is no pending action.

Offer of modified or alternative work form (RU-94): A form you get from the insurance company if: you were injured before 2004 and; your treating physician says you probably will never return to your job or one like it and; your employer is offering modified or alternative work instead of vocational rehabilitation benefits.

Offer of modified or alternative work (DWC form #AD 10133.53): A form you get from the insurance company if: you were injured in 2004 or later and; your treating physician reports you have a permanent disability and; your employer is offering modified or alternative work instead of a supplemental job displacement benefit. This form also explains how your permanent disability payments may be lowered by 15 percent because your employer is returning you to work.

Panel qualified medical evaluator (QME): A list of three independent qualified medical evaluators (QMEs) issued by the DWC Medical Unit. You select any one of the three doctors for your evaluation. If you have an attorney, other rules apply.

Party: Normally this includes the insurance company, your employer, attorneys and any other person with an interest in your claim (doctors or hospitals that have not been paid).

Permanent and stationary (P&S): Your medical condition has reached maximum medical improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted from your work injury. If your disability is rated under the 2005 schedule you will see the term maximal medical improvement (MMI) used in place of P&S. See also P&S report.

Permanent disability (PD): Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached.

Permanent disability rating (PDR): A percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity. It determines the number of weeks you are entitled to permanent disability benefits.

Permanent disability rating schedule (PDRS): A DWC publication containing detailed information used to rate permanent disabilities. One of three schedules will be used to rate your disability, depending on when you were injured.

Permanent disability (PD) benefits: Payments you receive when your work injury permanently limits the kinds of work you can do or your ability to earn a living.

Permanent disability advance (PDA): A voluntary lump sum payment of permanent disability you are due in the future.

Permanent disability payments: A mandatory bi-weekly payment based on the undisputed portion of permanent disability received before and/or after an award is issued.

Permanent partial disability award: A final award of permanent partial disability made by a workers’ compensation judge or the Workers’ Compensation Appeals Board.

Permanent partial disability (PPD) benefits: Payments you receive when your work injury partially limits the kinds of work you can do or your ability to earn a living.

Permanent total disability (PTD) benefits: Payments you receive when you are considered permanently unable to earn a living.

Penalty: An amount of money you receive because something wasn’t done correctly in your claim. Paid by your employer or the insurance company, the penalty amount can be an automatic 10 percent for a delay in one payment to you, or a 25 percent penalty — up to $10,000 — for an unreasonable delay.

Personal physician: A doctor licensed in California with an M.D. degree (medical doctor) or a D.O. degree (osteopath), who has treated you in the past and has your medical records.

Petition for reconsideration (Recon): A legal process to appeal a decision issued by a workers’ compensation judge. Heard by the Workers’ Compensation Appeals Board Reconsideration Unit, a seven- member, judicial body appointed by the governor and confirmed by the Senate.

Physician: A medical doctor, an osteopath, a psychologist, an acupuncturist, an optometrist, a dentist, a podiatrist or a chiropractor licensed in California. The definition of personal physician is more limited. See personal physician.

Pre-designated physician: A physician that can treat your work injury if you advised your employer in writing prior to your work injury or illness and certain conditions are met. See pre-designation.

Pre-designation: The process you use to tell your employer you want your personal physician to treat you for a work injury. You can pre-designate your personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) if: your employer offers group health coverage; the doctor has treated you in the past and has your medical records; prior to the injury your doctor agreed to treat you for work injuries or illnesses and; prior to the injury you provided your employer the following in writing:

(1) Notice that you want your personal doctor to treat you for a work-related injury or illness and (2) Your personal doctor’s name and business address.

Primary treating physician (PTP): The doctor having overall responsibility for treatment of your work injury or illness. This physician writes medical reports that may affect your benefits. Also called treating physician or treating doctor.

Proof of service: A form used to show that documents have been sent to specific parties. P&S report: A medical report written by a treating physician that describes your medical condition when

it has stabilized. See also permanent and stationary.

Qualified injured worker (QIW): Entitled to vocational rehabilitation benefits. This benefit applies only if you were injured before Jan. 1, 2004.

Qualified medical evaluator (QME): An independent physician certified by the DWC Medical Unit to perform medical evaluations.

Qualified rehabilitation representative (QRR): A person trained and able to evaluate, counsel, and place disabled workers in new jobs. Also called rehabilitation counselor.

Rating: See permanent disability rating.

Reconsideration: See petition for reconsideration.

Reconsideration Unit: See appeals board.

Reconsideration of a summary rating: A process used when you don’t have an attorney and you think mistakes were made in your permanent disability rating.

Regular work: Your old job, paying the same wages and benefits as paid at the time of an injury and located within a reasonable commuting distance of where you lived at the time of your injury.

Rehabilitation consultant: A DWC employee who oversees vocational rehabilitation procedures, makes decisions about vocational rehabilitation benefits and helps resolve disputes.

Rehabilitation counselor: See qualified rehabilitation representative (QRR).

Rehabilitation Unit: A unit within DWC that resolves vocational rehabilitation disputes, approves potential settlements of vocational rehabilitation services, and reviews and approves vocational rehabilitation plans for injuries that happened before Jan. 1, 2004.

Restrictions: See work restrictions. Schedule for rating permanent disabilities: See permanent disability rating schedule.

Settlement: An agreement between you and the insurance company about your workers’ compensation payments and future medical care. Settlements must be reviewed by a workers’ compensation judge to make sure they are adequate.

Serious and willful misconduct (S&W): A petition filed if your injury is caused by the serious and willful misconduct of your employer.

Social Security disability benefits: Long-term financial assistance for totally disabled persons. These benefits come from the U.S. Social Security Administration. They are reduced by workers’ compensation payments you receive.

Specific injury: An injury caused by one event at work. Examples: hurting your back in a fall, getting burned by a chemical splashed on your skin, getting hurt in a car accident while making deliveries.

State average weekly wage: The average weekly wage paid in the previous year to employees in California covered by unemployment insurance, as reported by the U.S. Department of Labor. Effective 2006, temporary disability benefit increases are tied to this index.

State disability insurance (SDI): A partial wage-replacement insurance plan paid out to California workers by the state Employment Development Department (EDD). SDI provides short-term benefits to eligible workers who suffer a loss of wages when they are unable to work due to a non work-related illness or injury, or a medically disabling condition from pregnancy or childbirth. Workers with job injuries may apply for SDI when workers’ compensation payments are delayed or denied. Call 1-800-480-3287 for more information on SDI.

Stipulated rating: Formal agreement on your permanent disability rating. Must be approved by a workers’ compensation judge.

Stipulation with award: A settlement of a case where the parties agree on the terms of an award. This is the document the judge signs to make the award final.

Stipulations with request for award (Stips): A settlement in which the parties agree on the terms of an award. It may include future medical treatment. Payment takes place over time. This document is provided to the judge for final review.

Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker’s permanent disability. Subjective factors are given very little weight under the 2005 rating schedule as the schedule relies mainly on objective measurements.

Subpoena: A document that requires a witness to appear at a hearing. Subpoena Duces Tecum (SDT): A document that requires records be sent to the requester.

Summary rating: The percentage of permanent disability calculated by the DWC Disability Evaluation Unit.

Summary rating reconsideration: A procedure used if you object to the summary rating issued by the DWC Disability Evaluation Unit.

Supplemental job displacement benefit (SJDB): A workers’ compensation benefit. If you were injured in 2004 or later, and have a permanent partial disability that prevents you from doing your old job, and your employer does not offer other work, you qualify for this benefit. It is in the form of a voucher that promises to help pay for educational retraining or skill enhancement, or both, at state- approved or state-accredited schools. Also called voucher.

Temporary disability (TD or TTD): Payments you get if you lose wages because your injury prevents you from doing your usual job while recovering.

Temporary partial disability (TPD) benefits: Payments you get if you can do some work while recovering, but you earn less than before the injury.

Temporary total disability (TTD) benefits: Payments you get if you cannot work at all while recovering.

Transportation expenses: A benefit to cover your out-of-pocket expenses for mileage, parking and toll fees related to a claim. Usually a reimbursement.

Treating doctor: See primary treating physician. Treating physician: See primary treating physician.

Uninsured Employers Fund (UEF): A fund, run by the DWC, through which your benefits can be paid if your employer is illegally uninsured for workers’ compensation.

Utilization review (UR): The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.

Vocational & return to work counselor (VRTWC): If you have a permanent disability, this is the person or entity that helps you develop a return to work strategy. They evaluate you, provide counseling and help you get ready to work. A VRTWC must have at least an undergraduate degree in any field and three or more years of full time experience.

Vocational rehabilitation (VR): A workers’ compensation benefit. If you were injured before 2004 and are permanently unable to do your usual job, and your employer does not offer other work, you qualify for this benefit. It includes job placement counseling to help you find another job. It may also include retraining and a vocational rehabilitation maintenance allowance.

Vocational rehabilitation maintenance allowance (VRMA): Payments to help you with living expenses while participating in vocational rehabilitation. See vocational rehabilitation.

Voucher: See supplemental job displacement benefit and nontransferable voucher. Wage loss (temporary partial disability): See temporary partial disability benefits.

Workers’ Compensation Appeals Board (WCAB): Consists of 24 local offices throughout the state where disagreements over workers’ compensation benefits are initially heard by workers’ compensation judges. The WCAB Reconsideration Unit in San Francisco is a seven-member, judicial body appointed by the governor and confirmed by the Senate that hears appeals of decisions issued by local workers’ compensation judges.

Workers’ Compensation Insurance Rating Bureau (WCIRB): An agent of the state Department of Insurance and funded by the insurance industry, this private entity provides statistical and rating information for workers’ compensation insurance and employer’s liability insurance, and collects and tabulates information to develop pure premium rates.

Work restrictions: A doctor’s description of the work you can and cannot do. Work restrictions help protect you from further injury.

Workers’ compensation administrative law judge: A DWC employee who makes decisions about workers’ compensation disputes and approves settlements. Judges hold hearings at local Workers’ Compensation Appeals Board (WCAB) offices, and their decisions may be reviewed and reconsidered by the Reconsideration Unit of the WCAB. Also called workers’ compensation judge.

Workers’ compensation judge: See workers’ compensation administrative law judge.

 

Glossary of Terms Social Security

Americans with Disabilities Act of 1990 (ADA)
Public Law 101-336 gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications.

For more information about the ADA, go to http://www.ada.gov/

Area Work Incentives Coordinator (AWIC)
The AWIC is a Social Security Administration employee who serves as an expert on SSA’s work incentives and employment support programs in a specific geographic area of the country. He/she manages and coordinates work incentive training; conducts public outreach; and provides public support services to beneficiaries with disabilities who want to start or keep working and to other members of the community.

B

Beneficiary
An individual who receives either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits from the Social Security Administration (SSA).

Benefits Planning Query (BPQY))
The BPQY is a planning tool that can be used by Area Work Incentives Coordinators, Plan for Achieving Self Support (PASS) Cadre employees and Work Incentive Planning and Assistance (WIPA) projects to provide customized employment services to beneficiaries with disabilities who want to start or keep working. A BPQY provides a snapshot of a beneficiary’s current status as stored in the Social Security Administration’s electronic records. It contains comprehensive information about an individual’s disability cash benefits, health insurance, medical review schedule, representative payee status and work history. Analysis of an individual’s disability and work status is the first step when planning a successful return to work initiative.

Blind Work Expenses (BWE) (SSI)
If you are blind, we do not count any earned income that you use to meet expenses in earning that income when we decide your SSI eligibility and payment amount.

For example, BWEs include: transportation to and from work, income taxes, attendant care services, and service animal expenses. For more information go to: http://www.socialsecurity.gov/redbook/2010/blindrules.htm

BPAO
The Benefits Planning, Assistance and Outreach (BPAO) project was replaced by the Work Incentives Planning and Assistance project (WIPA) in October 2006.

Break-Even Point (SSI)
The dollar amount of total income that will (after applicable deductions are applied) reduce the SSI payment to zero in a given set of case facts. Your break-even point depends on your earned and unearned income, living arrangements, applicable income exclusions, and state supplement, if any. While useful for discussion purposes, this term does not appear in the SSI rules.

C

Centers for Medicare and Medicaid Services (CMS)
The U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services administers Medicare, Medicaid, and the State Children’s Health Insurance Program.
http://www.cms.hhs.gov/

Community Work Incentives Coordinator (CWIC)
A CWIC is employed by the Work Incentives Planning and Assistance (WIPA) project and works directly with Social Security beneficiaries with disabilities to assist them in their employment efforts. CWICs provide outreach to beneficiaries with disabilities and work incentives planning and assistance.
CWICs:

  • Work in cooperation with Federal, State, private agencies, and nonprofit organizations that serve beneficiaries with disabilities;
  • Conduct outreach to beneficiaries with disabilities (and their families), employment-related organizations, disability service providers, special education transition coordinators, and other groups and individuals who need information about SSA’s Work Incentives and the Ticket to Work Program;
  • Screen and refer beneficiaries with disabilities to appropriate Employment Networks based on the beneficiary’s expressed needs and types of impairments;
  • Provide general information on the adequacy of health benefits coverage that may be offered by an employer of a beneficiary with a disability and the extent to which other health benefits coverage may be available to that beneficiary in coordination with Medicare and/or Medicaid; and
  • Provide information on the availability of protection and advocacy services for beneficiaries with disabilities and how to access such services.

Continuation of Medicare Coverage (SSDI)
You can receive at least 93 consecutive months of hospital and medical insurance after the trial work period. This provision allows health insurance to continue when you go to work and are engaging in substantial gainful activity (SGA).

Continued Medicaid Eligibility
See Medicaid While Working [Section 1619(b)]

Continuing Disability Review (SSDI and SSI)
Our process of obtaining complete current information about your condition and any work activity to decide if your SSDI and/or SSI benefits should continue.

Cost Reimbursement Payment System
The system providing payment from the Social Security Administration to State vocational rehabilitation agencies and alternate participants for reasonable and necessary costs for vocational rehabilitation and other employment support services to SSDI and SSI beneficiaries with disabilities.

Countable Income (SSI)
The amount of money left after we have subtracted all available deductions from your total income. We use this amount to determine your SSI eligibility and payment amounts.

D

Deeming (SSI)
Our process of considering some of the income and resources of your parent, or spouse, or sponsor (if you are an alien) to be your income and resources when you are applying for or receiving SSI benefits.

Definition of Disability (SSDI and SSI)
The inability to engage in any substantial gainful activity because of a medically determinable physical or mental impairment(s) which has lasted or can be expected to last for at least 12 months or can be expected to result in death.

E

U.S. Equal Employment Opportunity Commission (EEOC)
The Commission promotes equality of opportunity in the workplace and enforces federal laws prohibiting employment discrimination.
http://www.eeoc.gov/

Earned Income Tax Credit (EITC)
This is a refundable federal income tax credit for low-income working individuals and families. Congress originally approved the tax credit legislation in 1975 in part to offset the burden of Social Security taxes and to provide an incentive to work. To qualify, taxpayers must meet certain requirements and file a tax return, even if they did not earn enough money to be obligated to file a tax return.

Employment Network (EN)
A qualified public or private organization that has entered into a contract with SSA to function as an employment network under the Ticket to Work program and assume responsibility for the coordination and delivery of employment services, vocational rehabilitation services, or other support services to beneficiaries who have assigned their Tickets to that employment network. To learn more, please click here.

Employment Plan
An individual work plan under which an employment network (other than a State vocational rehabilitation agency) provides services to a Social Security Disability Insurance or Supplemental Security Income beneficiary with a disability under the Ticket to Work program, or an individualized plan for employment under which a State Vocational Rehabilitation agency provides services.

Employment Supports
Also known as work incentives. Congress developed employment supports to give individuals with disabilities assistance to move from benefit dependence to independence.

Expedited Reinstatement
A qualified individual may request reinstatement of benefits, within 5 years of benefits having stopped, without having to file a new application. Up to 6 months of provisional benefits are available while we make a decision on the request.

Extended Period of Eligibility (SSDI)
During the 36 consecutive months following the trial work period, if you qualify, we may restart your SSDI benefits without a new application, disability determination, or waiting period.

I

Impairment-Related Work Expenses (IRWE) (SSDI and SSI)
We deduct the cost of items and services that you need to work because of your impairment (e.g., attendant care services, medical devices, etc.) when we decide if you are engaging in substantial gainful activity. It does not matter if you also need the items for normal daily activities. We can usually deduct the cost of these same items from earned income to figure your SSI payment.

Income (SSI)
SSI income includes:

  • Earned income — money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, and some royalties and honoraria; and
  • Unearned income — money received from all other sources, e.g., gifts, interest, Social Security benefits, Veterans benefits, and pensions. Unearned Income also includes “in-kind income” (free food, clothing or shelter) and “deemed income” (some of the income of a spouse, or parent, or sponsor of an alien).

Income Exclusions (SSI)
Generally, if the item received cannot be used as, or to obtain, food, clothing, or shelter, we do not consider it as income. Income exclusions are used to determine countable income.

Earned income exclusions include:

  • The first $65 per month plus one-half of the remaining earnings;
  • Impairment-related work expenses or blind work expenses;
  • Income you set aside or use to pursue a Plan for Achieving Self-Support.

Unearned income exclusions include:

  • The first $20 per month;
  • Income you set aside or use to pursue a Plan for Achieving Self-Support;
  • State or locally funded assistance based on need;
  • Rent subsidies under HUD programs and the value of food stamps;
  • Infrequent or irregularly received income ($20 or less a month).

General earned income exclusion
The first $65 ($85 if you have no income other than earnings) of any monthly earned income plus one-half of remaining earnings.

Individual Employment Plan (IEP)
An intensive service provided through the one-stop delivery system. Development of a plan to identify the employment goals, appropriate achievement objectives, and appropriate combination of services for the participant to achieve the employment goals.

Individualized Plan for Employment (IPE)
A written plan of action which outlines the employment goal, criteria to evaluate progress toward the employment goal and the services to be provided. It is developed for each individual who is determined to be eligible for vocational rehabilitation services through the state Vocational Rehabilitation (VR) agency Contact your state VR agency for more information.

Individual Work Plan (IWP)
A required written document signed by an Employment Network (EN) (other than a State Vocational Rehabilitation agency) and a beneficiary, or a representative of a beneficiary, with a Ticket to outline the specific employment services, vocational rehabilitation services and other support services that the EN and beneficiary have determined are necessary to achieve the beneficiary`s stated employment goal.

M

Medicaid (Medi-Cal in California, AHCCS in Arizona) (SSI)
Medical coverage provided to a person by the State title XIX program.

Medicaid Protection for People with Disabilities Who Work (SSI)
For people with disabilities who: have earnings that are too high to qualify for Medicaid under current rules; are at least 16, but less than 65 years of age, and meet state resource and income limits, a state may provide Medicaid coverage. A state may also provide Medicaid coverage to these individuals when they lose coverage due to medical improvement, but still have a medically determinable severe impairment.

Medicaid While Working [Section 1619(b)] (SSI)
This is an employment support that is different than Medicaid Protection for People with Disabilities Who Work. Here your Medicaid coverage can continue, even if your earnings alone or in combination with your other income become too high for a SSI cash payment. To qualify you must have been eligible for a SSI cash payment for at least 1 month; still be disabled; still meet all other eligibility rules, including resource test; need Medicaid in order to work and have gross earned income that in insufficient to replace SSI, Medicaid and any publicly funded attendant care.

Medicare (SSDI)
Health insurance program for eligible disabled individuals and individuals age 65 or older usually consisting of:

  • Hospital Insurance under Medicare (Part A);
  • Supplementary Medical Insurance under Medicare (Part B); and
  • Voluntary prescription drug coverage with a Prescription Drug Provider (PDP) under Part D.

Low-income beneficiaries with Medicare can get extra help paying their prescription drug coverage premiums by filing an application with SSA. More information is available at: www.socialsecurity.gov/prescriptionhelp/.

Medicare for People With Disabilities Who Work (SSDI)
Some people with disabilities who have returned to work can buy continued Medicare coverage when their premium-free Medicare ends due to work activity. States are required to help pay the hospital insurance premiums for some working individuals with disabilities.

Medical Improvement Expected (MIE)
When we decide you have a disabling impairment, and we also decide that the disabling impairment(s) may improve, we document that your case will need a future review.

Medicaid Infrastructure Grants (MIG)
Section 203 of the Ticket to Work and Work Incentives Improvement Act of 1999 establishes a grant program to support state efforts to enhance employment options for people with disabilities. CMS is the designated agency with administrative responsibility for this grant program.

Medical Improvement Not Expected (MINE)
When we decide you have a disabling impairment and also decide the disabling impairment(s) will not improve.

Medical Improvement Possible (MIP)
When we decide you have a disabling impairment and also decide that the disabling impairment(s) may improve.

O

Office of Disability Employment Policy (ODEP)
The U.S. Department of Labor’s Office of Disability Employment Policy provides national leadership by developing and influencing disability-related employment policy and practice affecting the employment of people with disabilities.

Outcome-Milestone Payment System
The system providing a schedule of payments under the Ticket to Work program to an employment network that includes, in addition to payments during the outcome payment period, payment for completion by a beneficiary of milestones directed toward the goal of permanent employment.

Outcome Payment System
The system providing a payments under the Ticket to Work program to an employment network for each month, up to a total of 60 months, during which Social Security disability benefits and Federal SSI cash benefits are not payable to a beneficiary because of the performance of substantial gainful activity (SGA) or by reason of earnings from work.

P

Plan for Achieving Self-Support (PASS)
Under an approved PASS, you may set aside income and/or resources over a reasonable time which will enable you to reach a work goal to become financially self-supporting. You then can use the income and resources that you set aside to obtain occupational training or education, purchase occupational equipment, establish a business, etc. We do not count the income and resources that you set aside under a PASS when we decide SSI eligibility and payment amount.

PASS Cadre
SSA employees who are specially trained to assist people when developing a Plan to Achieve Self-Support. PASS experts are located across the country, with at least 1 cadre in each of the 10 SSA regions.

Property Essential for Self Support (PESS)
We do not count some or all of certain property necessary for self-support when we apply the SSI resources test. For example, SSA does not count property such as tools or equipment that are used for work. Or, if an individual has a trade or business, SSA does not count property such as inventory.

PABSS Program
An organization in the private or public sector that has entered into a contract to assist SSA in administering the Ticket to Work program.

PABSS Program
Protection and Advocacy for Beneficiaries of Social Security Program (PABSS)

The Social Security Administration, as authorized by the Ticket to Work and Work Incentives Improvement Act of 1999, awarded Work Assistance Program grants to the designated Protection and Advocacy (P&A) system in each of the 50 States, the District of Columbia, the U.S. Territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, the Virgin Islands, and the P&A system for Native Americans. SSA`s P&A Program, known as Protection and Advocacy for Beneficiaries of Social Security (PABSS), was created to serve SSDI and SSI beneficiaries who want to work despite their continuing disabilities. PABSS grantees will:

  • Assist beneficiaries with disabilities in obtaining information and advice about receiving vocational rehabilitation and employment services; and
  • Provide advocacy or other related services that beneficiaries with disabilities may need to secure or regain gainful employment.

R

Red Book
A general reference source about SSDI and SSI employment supports. Published by the Social Security Administration, its purpose is to give a working knowledge of technical provisions so that rehabilitation professionals, advocates and counselors can appropriately advise individuals with disabilities who express an interest in starting or returning to work.

Resources (SSI)
Resources are anything you own, such as a bank account, stocks, business assets, real property, or personal property that you can use for your support and maintenance. We do not count all your resources when we determine your SSI eligibility.

S

SAMHSA
Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services, whose mission it is to focus on building resilience and facilitating recovery for people with, or at risk for, mental or substance use disorders.

 

Substantial Gainful Activity (SGA)
We evaluate the work activity of persons claiming or receiving disability benefits under SSDI, and/or claiming benefits because of a disability (other than blindness) under SSI. Under both programs, we use earnings guidelines to evaluate your work activity to decide whether the work activity is substantial gainful activity and whether we may consider you disabled under the law. While this is only one of the tests used to decide if you are disabled, it is a critical first step in a disability evaluation. (For SGA amounts, visitSGA Page.)

SSDI
Social Security Disability Insurance authorized under title II of the Social Security Act.

SSI
Supplemental Security Income program authorized under title XVI of the Social Security Act.

State Vocational Rehabilitation Agency (State VR agency)
The organization in each State, the District of Columbia or U.S. Territory, that is the designated governmental entity responsible for providing vocational rehabilitation services to persons with disabilities residing within its jurisdiction. In some States a separate State Vocational Rehabilitation agency also exists to provide assistance and services to individuals with a visual impairment.

Subsidies and Special Conditions (SSDI and SSI)
Supports you receive on the job that may result in more pay than the actual value of the work you perform. We use only the actual value of the work you perform when we make a SGA decision.

Supports you receive on the job that may result in more pay than the actual value of the work you perform. We use only the actual value of the work you perform when we make a SGA decision. Clarification on subsidies and special conditions.

T

Ticket Under the Ticket to Work Program (“Ticket”)
A document which provides evidence of the Commissioner`s agreement to pay an employment network or a State vocational rehabilitation agency, to which a disabled beneficiary`s Ticket is assigned, for providing employment services, vocational rehabilitation services, and other support services to the beneficiary.

Ticket to Work Program
The Ticket to Work Program is a voluntary program that offers SSDI and SSI beneficiaries with disabilities a variety of choices in obtaining the support and services they need to help them go to work and achieve their employment goals. If you are eligible and would like to work or increase your current earnings, this program can help you get vocational rehabilitation, training, job referrals, and other ongoing support and services to help you do so.

Timely Progress
The guidelines SSA uses to determine if a beneficiary is making progress toward self-supporting employment.

Trial Work Period (SSDI)
The trial work period is an incentive for the personal rehabilitation efforts of SSDI beneficiaries who work. The trial work period lets you test your ability to work or run a business for at least 9 months and receive full SSDI benefits (no matter how high your earnings are) if you report your work activity and your impairment does not improve.

U

Unincurred Business Expenses (SSDI)
Support contributed to your self-employment effort by someone else. If you are self-employed, we deduct unincurred business expenses from earnings when we make a SGA decision.

Using a Ticket
The term used when a beneficiary has assigned a Ticket to an employment network or State vocational rehabilitation agency and is making timely progress toward self-supporting employment.

Unsuccessful Work Attempt (UWA) (SSDI)
An effort to do substantial work (in employment or self-employment) that you stopped or reduced to below the SGA level after a short time (6 months or less). This change must have resulted because of your impairment, or the removal of special conditions related to your impairment that was essential to the further performance of your work. We do not count earnings during an unsuccessful work attempt when we make an SGA decision.

V

Vocational Rehabilitation Services
Those services identified in the Rehabilitation Act of 1973, as amended, that are provided by a State Vocational Rehabilitation agency (VR) in an individualized plan for employment necessary to assist an individual with a disability in preparing for, securing, retaining, or regaining an employment outcome that is consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual.

W

Workforce Investment Act of 1998 (WIA)
Public Law 105-220 provides the framework for a national workforce preparation and employment system designed to meet both the needs of businesses and job seekers and those who want to further their careers. A key component of the Act enables customers to easily access the information and services they need through the One-Stop Career Center system.

Work Incentive Liaisons (WIL)
Each local Social Security Administration (SSA) office has a Work Incentive Liaison (WIL) who provides advice and information about SSA’s work incentive provisions and employment support programs to individuals with disabilities and outside organizations that serve those with disabilities. Contact your local SSA office for the name and telephone number of this Work Incentive Liaison

Work Incentives
Also known as employment supports. Congress developed employment support to give individuals with disabilities assistance to move from benefit dependence to independence.

Work Incentive Planning and Assistance Program (WIPA) Project
The Social Security Administration awards grants to community-based organizations as established by Section 121 of the Ticket to Work and Work Incentives Improvement Act 0f 1999, Public Law 106-170. The purpose of the WIPA project is to disseminate accurate information to SSA beneficiaries with disabilities about work incentives and employment support programs to better enable them to make informed choices about work. Each WIPA project employs Community Work Incentive Coordinators.

Tuesday, 21 September 2010 22:44

Become a Partner | NAIDW

Written by

Official Partner represents the premier-level philanthropic commitment to the overall mission of the NAIDW Foundation. The "Official Partner" and "Proud Member" of the NAIDW Foundation" logo and acknowledgment statement can be used in advertising, promotional and point-of-purchase materials.

NAIDW recognizes the importance of working with the right businesses and professionals to maximize our efforts in promoting information, resources, and advocacy for injured & disabled workers and their families.

Our sponsors and advertisers come along side the Association informally and formally to advance the mission of the Association and make a difference in the lives of the men, women, and families in our communities.

Although the word "sponsor" is used often we believe they are much more then that! We like to think of them as "partners" who help us advance our mission!

Displaying NAIDW OFFICAL PARTNER.png Displaying NAIDW PROUD MEMBER.png 

 


Corporate Sponsorship

 

We offer Five different Levels of Sponsorship:

As a fiscal corporate sponsor you will receive special incentives such as:

  1. 100% tax-deductible receipt!
  2. Advertising space on NAIDW website, NAIDW Professional Directory, & Injured Insider Publication, and email blasts!
  3. Sponsorship announcements at all special events, shows, and conferences!
  4. Free premium high priority listings in our professional directory with built in lead generation! (Showcase, Gold & Silver Sponsors)
  5. Special Badge on directory letting members know that you donated!
  6. Weekly social media 'Shout-Outs' to over 500,000+ supporters
  7. and much more!
National Showcase Sponsors - $25,000+
Diamond Sponsors - $10,000 - $24,999
Gold Sponsors - $2,500 - $9,999
Silver Sponsors - $1,000 - $2,499
Bronze Sponsors - $1 - $999

for up to $500 sponsorship you recieve a: bronz listing on our partners page under friends (No Backlinks, No Images), silver listing in our directory! ($295 value)

for 1K sponsorship you receive a: silver listing on our partners page (with backlink and co website with image), a premium high priority listings in our directory!($995 value) for 1 year with built in lead generation and much more!

for 2,500K sponsorship you receive a: gold listing on our partners page, (with backlink and co website with image) a premium high priority listings in our directory! plus side feature banner advertising for a year in our directory

for 5K+sponsorship you will receive a: gold listing on our partners page, (with backlink and co website with image) a premium high priority listings in our directory! plus side banner advertising for a year in our directory and main NAIDW.org and community.

for 10K+sponsorship you will receive diamond listing on our partners page, (with backlink and co website with image) a premium high priority listings in our directory! plus full banner advertising for a year in the main NAIDW.org website & directory and email blasts in our digital newsletter "injured insider" As a "panel member" will also get any state case evals and opportunity to HELP get involved with our local State Chapters. Unlimited access to the directory, blogs, deals, events, etc...

for 25K+ sponsorship you will receive a: Showcase National listing on our partners page, (with backlink and co website with image) premium high priority listings in our directory! plus full banner advertising for a year in the main NAIDW.org website & directory and email blasts in our digital newsletter "injured insider" as well as Sponsorship announcements at all special events, shows, and conferences. Unlimited access to the directory, blogs, deals, events,classifieds, etc...


Download our 2011 Media Kit
 
Download our Brochure -

Inside Outside


By Phone

Call Toll-Free at 888-788-NAIDW (6243) to make a gift by phone. We accept Visa, MasterCard, American Express and Discover.

Once again, Thank you for your generous contribution.

Click Here to download a tax deductible receipt.

Online Sponsorships

PayPal - The safer, easier way to pay online!

 

 

 

Use a credit card, debit card or checking account to make a secure donation through our online form. This service is good for up to $10,000

Once again, Thank you for your generous contribution. Click Here to download a tax deductible receipt.

By Mail

 
Make your checks payable to "NAIDW" and mail to
 
NAIDW | 43912 N. 50th Ln | Phoenix, AZ | 85087
 
Please make sure to write your phone number and email address on all checks. Also please include your business card or company logo!

Click Here to download a tax deductible receipt.

If you are interested in learning more about our sponsorship opportunities, please complete the form below and we will contact you to discuss opportunities in greater details.
 

5 reasons to Join Now!

1. We're Everywhere

Our marketing campaigns reach prospective clients
Google, Yahoo, Bing...We're there.

2. We're Affordable

At less than $3 a day for a diamond Membership,
you can't go wrong.

3. Posting a profile is easy

  1. Fill in the blanks
  2. Upload your photo
  3. Pay

4. Get New Clients

  • Built in Lead Generation
  • Homepage Spotlight
  • Enhanced Profile
  • Unrivaled Support
  • Search Engine Optimized
  • Social Media Ready
  • Visitor & Click Tracking
  • Clients can call or email you direct Search Enging Optimization Tools

5. Built In Marketing Tools

  • Badge System for Partners/Sponsors
  • Social Media Ready
  • Article Marketing
  • Event Marketing
  • Deals Marketing
  • Lead Generation
Sponsor Inquiries
Full Name (*)

Please type your full name.
Company or Firm (*)

Invalid Input
E-mail (*)

Invalid email address.
Phone (*)

Invalid Input
Comments

Invalid Input
ANTI-SPAM (*)
ANTI-SPAM
  Refresh
Invalid Input

  

 



Thursday, 16 September 2010 14:46

Workers' Compensation | NAIDW

Written by

 From Wikipedia, the free encyclopedia

Workers' compensation (colloquially known as workers' comp or workman's comp in North America and compo in Australia) is a form of insurance that provides compensation medical care for employees who are injured in the course of employment, in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The tradeoff between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain." While plans differ between jurisdictions, provision can be made for weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (past and future), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependants of workers killed during employment (functioning in this case as a form of life insurance). General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker compensation plans. Employees' compensation laws are usually a feature of highly developed industrial societies, implemented after long and hard-fought struggles by trade unions. Supporters of such programs believe they improve working conditions and provide an economic safety net for employees. Conversely, these programs are often criticised for removing or restricting workers' common-law rights (such as suit in tort for negligence) in order to reduce governments' or insurance companies' financial liability. These laws were first enacted in Europe and Oceania, with the United Statesfollowing shortly thereafter.

Compensation before statutory law

Before the statutory establishment of workers' compensation, employees who were injured on the job were only able to pursue their employer through civil or tort law.[1] In the United Kingdom, the legal view of employment as a master-servant relationship required employees to prove employer malice or negligence, a high burden for employees to meet. Although employers' liability was unlimited, courts usually ruled in favor of employers, paying little attention to the full losses experienced by workers, including medical costs, lost wages, and loss of future earning capacity.

Statutory compensation law

Statutory compensation law provides advantages to employees and employers. A schedule is drawn out to state the amount and forms of compensation to which an employee is entitled, if he/she has sustained the stipulated kinds of injuries. Employers can buy insurance against such occurrences. However, the specific form of the statutory compensation scheme may provide detriments. Statutes often award a set amount based on the types of injury. These payments are based on the ability of the worker to find employment in a partial capacity: a worker who has lost an arm can still find work as a proportion of a fully-able person. This does not account for the difficulty in finding work suiting disability. When employers are required to put injured staff on "light-duties" the employer may simply state that no light duty work exists, and sack the worker as unable to fulfill specified duties. When new forms of workplace injury are discovered, for instance: stress, repetitive strain injury,silicosis; the law often lags behind actual injury and offers no suitable compensation, forcing the employer and employee back to the courts (although in common-law jurisdictions these are usually one-off instances). Finally, caps on the value of disabilities may not reflect the total cost of providing for a disabled worker. The government may legislate the value of total spinal incapacity at far below the amount required to keep a worker in reasonable living conditions for the remainder of his life. A related issue is that the same physical loss can have a markedly different impact on the earning capacity of individuals in different professions. For instance, the loss of a finger could have a moderate impact on a banker's ability to do his or her job, but the same injury would totally ruin a pianist.

Statutory compensation in the United States

At the turn of the 19th century workers’ compensation laws were voluntary for a couple of reasons. Specifically, an elective law made passage easier and many felt that compulsory workers’ compensation laws would violate the 14th amendment due process clause of the U.S. Constitution. Since workers’ compensation mandated benefits without regard to fault or negligence, many felt that compulsory participation would deprive the employer of property without due process. The issue of due process was resolved by the United States Supreme Court in 1917 when in New York Central Railway Co. v. White it was held that an employer’s constitutional rights weren't affected. After the ruling most states enacted new compulsory workers’ compensation laws. In 1855, Georgia and Alabama passed Employer Liability Acts; 26 other states passed similar acts between 1855-1907. These acts simply permitted injured employees to sue the employer and then prove a negligent act or omission.[11][12] (A similar scheme was birthed in Britain's 1880 Act.[13]) After Germany's 1884 Act, workers' compensation laws began to be reformed to reduce the need for litigation, and to mitigate the requirement that injured workers prove their injuries were their employer's "fault". For example, The 1897 British Act replaced the 1880 Act. In the United States, the first state such worker's compensation law was passed in Maryland in 1902, and the first law covering federal employees was passed in 1906.[14] (See: FELA, 1908; FECA, 1916; Kern, 1918.) By 1949, all states had enacted some kind of workers' compensation regime.[15] Such schemes were originally known as "workman's compensation," but today, most jurisdictions have adopted the term "workers' compensation" as a gender-neutral alternative. In the United States, most employees who are injured on the job have an absolute right to medical care for any injury, and in many cases, monetary payments to compensate for resulting temporary or permanent disabilities. Most employers are required to subscribe to insurance for workers' compensation, and an employer who does not may have financial penalties imposed. Texas employers have the unique ability to opt out of the Workers' Compensation system under the original state law written in 1913. However, those employers, known as nonsubscribers, still need insurance coverage in the event of workplace injury. This then is how the nonsubscription industry in Texas began. Nonsubscription has proven to be a highly successful free market alternative to the government run workers' compensation system in Texas. Over 40% of Texas employers are nonsubscribers, including many of the state's larger and better known employers such as the H-E-B Grocery Company. Historically, these employers have had significantly greater satisfaction ratings and reduced expenses when compared to the workers’ compensation system.[16] In many states, there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance. Insurance policies are available to employers through commercial insurance companies: if the employer is deemed an excessive risk to insure at market rates, it can obtain coverage through an assigned-risk program. Workers' compensation is administered on a state-by-state basis, with a state governing board overseeing varying public/private combinations of workers compensation systems.[17] The federal government has its own workers' compensation program, subject to its own requirements and statutory parameters for federal employees. In the vast majority of states, workers' compensation is solely provided by private insurance companies. 12 states operate a state fund (which serves as a model to private insurers and insures state employees), and a handful have state-owned monopolies. To keep the state funds from crowding out private insurers, they are generally required to act as assigned-risk programs or insurers of last resort, and they can only write workers' compensation policies. In contrast, private insurers can turn away the worst risks and can write comprehensive insurance packages covering general liability, natural disasters, and so on. Of the 12 state funds, the largest is California's State Compensation Insurance Fund. The federal government pays its workers' compensation obligations for its own employees through regular appropriations. The California Constitution, Article XIV section 4, sets forth the intent of the people to establish a system of workers' compensation. This section provides the Legislature with the power to create and enforce a complete system of workers' compensation and, in that behalf, create and enforce a liability on the part of any or all employers to compensate any or all of their employees for injury or disability, and their dependents, for death incurred or sustained by said employees in the course of their employment, irrespective of the fault of any employee. Further, the Constitution provides that the system must accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character. It was the intent of the people of California when they voted to amend the state constitution in 1918, to require the Legislature to establish a simple system that guaranteed full provision for adequate insurance coverage against liability to pay or furnish compensation. Providing a full provision for regulating such insurance coverage in all its aspects, including the establishment and management of a State compensation insurance fund; full provision for otherwise securing the payment of compensation; and full provision for vesting power, authority and jurisdiction in an administrative body with all the requisite governmental functions to determine any dispute or matter arising under such legislation, in that the administration of such legislation accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character. All of which matters is the people expressly declared to be the social public policy of this State, binding upon all departments of the State government.[18] It is illegal in most states for an employer to terminate or refuse to hire an employee for having reported a workplace injury or filed a workers' compensation claim. However, it is often not easy to prove discrimination on the basis of the employee's claims history. To abate discrimination of this type, some states have created a "subsequent injury trust fund" which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury. It is also suggested that laws should be made to prohibit inclusion of claims history in databases or to make it anonymous. (Seeprivacy laws.) Employees may not falsely claim benefits. There have been instances where the sub rosa videos recorded by private investigators show employees engaging in sports or other strenuous physical activities, although the employees allegedly suffered disability or injury.[citation needed] Such evidence may not be admissible at a trial, if it is found that the taping infringed on the employees' reasonable expectation of privacy.[citation needed] Some employers vigorously contest employee claims for workers' compensation payments. In any contested case, or in any case involving serious injury, a lawyer with specific experience in handling workers' compensation claims on behalf of injured workers should be consulted. Laws in many states limit a claimant's legal expenses to a certain fraction of an award; such "contingency fees" are payable only if the recovery is successful. In some states this fee can be as high as 40% or as little as 11% of the monetary award recovered, if any.[citation needed] In the vast majority of states, original jurisdiction over workers' compensation disputes has been transferred by statute from the trial courts to special administrative agencies.[citation needed] Within such agencies, disputes are usually handled informally by administrative law judges. Appeals may be taken to an appeals board and from there into the state court system. However, such appeals are difficult and are regarded skeptically by most state appellate courts, because the point of workers' compensation was to reduce litigation. A few states still allow the employee to initiate a lawsuit in a trial court against the employer. Ohio allows appeals to go before a jury.[19] Various organizations focus resources on providing education and guidance to workers' compensation administrators and adjudicators in various state and national workers' compensation systems. These include the American Bar Association (ABA), the International Association of Industrial Boards and Commissions (IAIBC), and the National Association of Workers' Compensation Judiciary (NAWCJ).

Statutory compensation in Florida

Florida workers’ compensation (WC) is a statutory program defined primarily by Chapter 440 Florida Statutes. Florida WC provides two primary benefits to workers with work-related injuries or illnesses. Medical care is defined by F.S. 440.13. Medical benefits may be delivered through a “managed care” plan, at the option of the employer. Indemnity, or “income replacement,” benefits are defined by F.S. 440.15. Indemnity is divided into “temporary” and “permanent.” These are expressions of “duration.” Each duration measure is subdivided into “partial” and “total” disability. These are expressions of “extent.” Indemnity is therefore potentially available for “temporary total,” “temporary partial,” “permanent partial,” and “permanent total.” Governmental oversight responsibility for the system is divided between the Division of Workers’ Compensation (DWC) and the Office of the Judges of Compensation Claims (OJCC). The DWC is part of the Department of Financial Services (DFS) and regulates the reporting of workplace injuries and illnesses. Insurance companies and self-insured employers are obligated to report claim information to the DWC thereafter. Examples of required data submissions include payment of medical bills, inception and cessation of indemnity benefits, and closure of the claim. The DWC also provides advice and assistance to injured workers through the Ombudsman or “Employee Assistance Office,” commonly called the “EAO.” The OJCC is an independent agency within the Division of Administrative Hearings (DOAH). An injured worker seeking benefits that are not administratively provided by the employer or its insurance carrier may seek an order from the OJCC compelling provision of that benefit(s). The request is made in the form of a “petition for benefits” or “PFB,” which is defined in F.S. 440.192. Each PFB is assigned to a Judge of Compensation Claims (JCC) in the geographic region in which the accident or illness occurred. Florida is divided into 17 such regions, called “Districts.” Each District is staffed by one to five JCCs. There are 33 JCCs in Florida. The filing of a PFB automatically triggers the court to order a mediation conference, which must be held within 130 days after the filing of the petition. Many claims for benefits are resolved between the parties before the mediation conference. Those issues that are not resolved before or during mediation will be scheduled for trial, or final merit hearing, before the assigned JCC. The final hearing must be held and concluded within 90 days after the mediation conference is held, allowing the parties sufficient time to complete discovery. The decisions of each JCC are reviewable by the First District Court of Appeal in Tallahassee, FL.

Statutory compensation in New York state

Workers' compensation is required by law for business owners to have in place for their employees. In March 2007, the state of New York adopted major reforms to its Workers' Compensation law. These reforms included an increase in available temporary disability payments for injured workers with the trade-off being that lifetime permanent partial disability benefits are no longer available for injuries after July 1, 2008. As with many systemic changes to broad legal schemes, the reforms have spawned significant litigation to clarify the meaning of many of the changed statutory sections. The Workers' Compensation Board has also attempted to resolve many more cases administratively, meaning that no hearing may be held to resolve a particular dispute, but this change has had unintended consequences. For example, injured workers may not sufficiently understand their rights, since an administrative decision may easily be confused with a proper legal determination (which it may not be). Injured workers are advised to consult an experienced Workers' Compensation attorney since consultation is free (a lawyer in New York cannot charge a fee regarding a Workers' Compensation claim without getting the fee approved by a Workers' Compensation Law Judge). In cities like Rochester, the Workers' Compensation Board has become a central location around which many of the experienced lawyers on both sides have located their offices. Owners of for-profit corporations are exempt from workers compensation insurance however non-profit companies do not get the exclusion.

Privatization

In recent years, workers compensation programs in West Virginia and Nevada were successfully privatized, through mutualization, in part to resolve situations in which the programs in those states had significantly underfunded their liabilities. Only four states rely on entirely state-run programs for workers compensation: North Dakota, Ohio, Washington, and Wyoming. Many other states maintain state-run funds but also allow private insurance companies to insure employers and their employees, as well.

Alternate forms of statutory compensation in the United States

Employees of common carriers by rail have a statutory remedy under the Federal Employers' Liability Act, 45 U.S.C. sec. 51, which provides that a carrier "shall be liable" to an employee who is injured by the negligence of the employer. To enforce his compensation rights, the employee may file suit in United States district court or in a state court. The FELA remedy is based on tort principles of ordinary negligence and differs significantly from most state workers' compensation benefit schedules. Seafarers employed on United States vessels who are injured because of the owner's or the operator's negligence can sue their employers under the Jones Act, 46 U.S.C. App. 688., essentially a remedy very similar to the FELA one.

Opposition to statutory compensation in the United States

Opponents argue that workers' compensation laws may hurt the U.S. workers they were designed to help[citation needed]. Large employers may have an incentive to move segments of their business—and their jobs—to areas where workers' compensation benefits (and other employee protections) are less generous or are harder to obtain. This is because the United States lacks a unified and national set of employee entitlements covering minimum wagewage and hour, or collective bargaining rights in addition to compensation. Labor unions describe this system as a race to the bottom, as state legislatures cut employee entitlements to attract capital. Moreover, applying laws to citizens (or organisations) abroad, is an exception rather than the rule under common law. United States employers can also move some operations to other countries where employee entitlements are much lower than in the U.S., and where there may be no workers' compensation or other legal remedies at all for workers who are injured or who are exposed to hazardous substances while on the job. Such countries may also have weaker or no legal protections available for employees in areas such as job discriminationsocial security, or the right to organize or to join a trade union. Some small business owners complain that the cost of workers’ compensation, which they pay in the form of insurance premiums, places a heavy burden on them. Economists who favor the distributism system of economics cite workers' compensation as an example of how far the modern capitalist economic system approaches what they call the "servile state" or "slavery worker" system. They say that in past times, when ownership of the means of production were more widely distributed, it would not be natural to hold an employer responsible for a worker's injury, since the worker was freely choosing to work for that employer. Distributors assert that in modern times, with the vast majority of people dispossessed of the means of production, requiring employers to have workers compensation shows how much workers really are dependent on being employed and are essentially forced to work for someone else to survive. Some distributors who feel that capitalism is heading in the direction of a slavery system feel that this will come about by workers exchanging their personal freedom for economic benefits like workers' compensation.[citation needed]

Workers' compensation cost containment

Many things can be done to reduce the cost of workers' compensation. While many business owners and managers initially think "workers' compensation is the cost of doing business," this is not really true and there are many controls that can be put in place inside a company to make sure an employer pays only for legitimate injuries, from the time an employee is medically unable to return to anyproductive task at the workplace. This field of risk management is a specialized niche called "post loss cost containment," "injury management cost reduction," and several other names. The specialty centers around actions an employercan do to "manage" the processes in the workplace immediately after an injury occurs. There are four stages to the workers' compensation cost containment process including: assessment & recommendations, design & development, implementation and rollout.

Cost drivers

The areas generally considered to be key cost drivers are:
  • building management commitment,
  • working with the insurance company & insurance adjusters,
  • implementing an effective return to work & transitional duty program,
  • coordinating medical care,
  • medical cost management,
  • recognizing fraud and abuse,
  • self-interested defense counsel
  • improving communication with employees, and
  • training supervisors.
Employers should use a "holistic" approach to workers' compensation cost containment by looking at the total problem, rather than focusing only on one area such as reducing medical bills. By taking a "can do" approach, employers focus on controlling procedures within their control rather than the many things they cannot control. For example, employers cannot quickly or easily change the workers' compensation laws or eliminate plaintiff's lawyers or the legal system, items that are frequently mentioned as "causes" of high workers' compensation costs; however, an employer can implement a "post-injury response procedure" in their own workplace specifying what an employee must do if injured. Employers must "take charge" of those things within their control. Employers should also do after-action reviews (AARs) when an individual claimant's case has cost an extraordinary amount or resulted in extensive litigation to try and determine what went wrong. Often the biggest driver in costs is a failure to recognize a meritorious claim quickly. Delayed treatment can result in a need for much more extensive treatment and/or the futility of all efforts at healing and eventual return to competitive employment. An injured worker's sense of having been the victim of an unjust litigation process can also lead to increased rates of consequential depression and other mental health conditions which create a complicating "overlay" to an initial physical injury. In the United States, there has developed a relatively small industry of cost control consultants who review Workers' Compensation insurance premium charges for employers in order to find and correct overcharges caused by technical errors by insurers. These consultants are known as Workers Compensation Third Party Administrators. Part of their function typically is to review classification codes, payroll audits, and experience modification factor calculations. These consultants reduce Workers' Compensation costs by correcting errors in insurance premium calculations, rather than by reducing claims costs.

Policies

Having consistent policies and forms helps the employer remain in control of the process. Even very small companies should have a tight post-injury procedure to help management control the post-injury process. The overall goal is for 95% of injured employees to return to work within 1–4 days after the injury unless they are medically unable to perform any productive role for the employer. The time out of work should be proportionate to the length of the disability. The Average Cost Per Employee in 2009, according to the 2009 RIMS Benchmarking Survey is $721 for all employers combined. Some documents and policies to use are:
  • Transitional Duty Policy
  • Work Ability Form
  • Transitional Assignment Form
  • Post Injury Procedure
  • Worst-to-Best Benchmark Performance List
  • Employee Brochure
  • Introduction Letter to Employees
  • Employee Acknowledgement Form
  • Physician Telephone Contact Questionnaire
  • Supervisors Guide to Workers' Compensation
  • General Manager Best Practices

Further considerations

In general, statutory Workers' Compensation systems strike a compromise, guaranteeing workers medical care and payment for lost time on a no-fault basis. Before the enactment of Workers' Compensation laws, injured workers had to file suit against employers (usually for the tort of negligence), and such legal actions had significant drawbacks for workers. At the same time, a successful suit could impose very large and unpredictable costs on an employer. Statutory Workers' Compensation systems provide for prompt payment of medical, rehabilitation, and lost time costs to injured workers, while placing limits on the cost of the system for employers. This trade-off became known as the "workers' compensation bargain"; that is, the worker traded his/her right to bring a tort suit against their employer in exchange for prompt medical care and disability payments (indemnity payments). Thus workers compensation is the original "Tort reform". In many states today, Workers' Compensation represents a major cost of business for employers, and there is ongoing political maneuvering by both business and labor groups to shift the compromise balance struck by Workers' Compensation statutes (for an example see California's Senate Bill (SB) 899). In general, business groups seek to limit the cost of Workers' Compensation coverage, while labor groups seek to increase benefits paid to workers. Workers’ compensation in Texas remains generally elective meaning that most private sector employers can choose to subscribe to workers’ compensation or operate as a Texas nonsubscriber. Nonsubscription wasn't a major issue until the late 1980s when workers' compensation premiums escalated, on average, 150%. In response, businesses provided injury benefit plans to offer occupational injury benefits to employees as nonsubscribers.[20] For many employers, nonsubscription has been a choice that kept their operations in Texas and aided them in providing better care to their employees. The Texas Association of Business Organization believes that this critical workplace tool must be preserved. Over 40 percent of Texas businesses are nonsubscribers, who historically have had significantly greater satisfaction ratings and reduced expenses when compared to the workers’ compensation system.[16] For the commercial insurance market, Workers' Compensation represents a major line of business, although one that is sometimes problematic for the insurance industry. Premiums are large, but many insurers find it difficult to turn a profit in many states, as benefit costs sometimes exceed premiums. This line of insurance is regulated fairly closely by most states, although in recent years many states have allowed insurance companies greater flexibility in pricing this line of coverage. The hope has been that by encouraging price competition among insurers for Workers' Compensation insurance, employers would benefit by being able to obtain lower overall premiums. However, the introduction of competitive pricing for Workers' Compensation insurance has also led to significant swings in cost, as the insurance market moves between 'hard' and 'soft' markets. Employers often benefit from lower premiums in 'soft' insurance markets, only to see their premiums increase exponentially during 'hard' insurance markets.[21] Injured Workers sometimes complain that insurance companies do not treat them fairly or in compliance with the law, while employers often complain about their costs of insurance being driven up by exaggerated or fraudulent claims. Thus, the field engenders a considerable amount of controversy and litigation. These disputed areas include both claims and premium computations. The statute of limitations for filing a compensation claim for an accidental injury varies from state to state.

References

  1. ^ The Encyclopedia of Work-Related Illnesses, Injuries, and Health Issues
  2. ^ workcover.nsw.gov.au About Us
  3. ^ About WorkSafe Victoria – WorkSafe Victoria is the manager of Victoria's workplace safety system. Broadly, the responsibilities of WorkSafe are the following: * help avoid workplace injuries occurring * enforce Victoria's occupational health and safety laws * provide reasonably priced workplace injury insurance for employers * help injured workers back into the workforce * manage the workers' compensation scheme by ensuring the prompt delivery of appropriate services and adopting prudent financial practices.
  4. ^ What do WorkCover do? * safety and prevention including producing publications, education seminars * assisting business with an advisory service * accreditation of medical practitioners * ensuring that employers are insured * licensing of insurers * promotion of special events such as Safe Work Tasmania Week and the WorkCover Safety Awards
  5. ^ An Act for Insurance Against Accidents, July 6, 1884, translated and reprinted in F.W. Taussig, Workmen’s Insurance in Germany, 2 Q. J. ECON. 111 app. at 121-28 (1887)
  6. ^ US Dept. of Labor, The Job Safety Law of 1970: Its Passage Was Perilous
  7. ^ Holborn, Hajo: A History of Modern Germany — 1840–1945: Princeton University Press; 1969; pp. 291–93.
  8. ^ Munich Re - History of workers' compensation insurance in Germany
  9. ^ washburnlaw.edu, Compensation for Personal Injuries in a Comparative Perspective
  10. ^ HSE: Information about health and safety at work
  11. ^ wvu.edu
  12. ^ loislaw.com re: THE EMPLOYERS' LIABILITY CASES, 207 U.S. 463 (1908)
  13. ^ lawphil.net "The Employers' Liability Act of Alabama, first enacted in 1855 (Civil Code 1907, Ch. 80, sec. 3910), is a substantial, if not an exact copy, of the English Act of 1880."
  14. ^ The Federal Employers Liability Law of 1906 The 1906 law was declared unconstitutional by the Supreme Court; re-worked by Congress in 1908
  15. ^ eh.net FishbackIncludes extended data tables.
  16. a b Texas Association of Business Nonsubscription
  17. ^ Health Harbor - Health Harbor | Health Coverage - Using Your Insurance | Workers Compensation
  18. ^ See California Workers' Compensation Claims and Benefits, by Judge David W. O'Brien JudgeOBrien.com
  19. ^ See Ohio Rev. Code Section 4123.512.
  20. ^ Texas Association of Responsible Nonsubscribers (TXANS) FAQ concerning Nonsubscribing to Workers' Compensation in Texas
  21. ^ Ultimate Guide to Workers' Compensation Insurance, Edward J. Priz, Entrepreneur Press, 2005, p. 109
Page 4 of 6

How Can We Help You?

Resources In Your Area!

OSHA HELP

If you are facing an immediate danger or hazard at work please CALL 1-800-321-OSHA TO NOTIFY OSHA OR CLICK HERE to find a map and phone directory of OSHA offices.

Live Community Chat

Crowd Funding

FREE Advertising

Share your story

SSL- Site Security

As added security NAIDW.org uses SSL, 256-bit encryption and user authentication to secure its content over the Internet. Your personal profile and health information is protected by SSL encryption, and will not be redistributed or resold.

Blog With Us

Volunteer

Join Today! It's FREE!

Featured Videos

Donate Today!

FREE Case Evaluation!



Login | Register

FREE RX Drug Card!

FREE Awareness Material

Forum Activity

More Topics »

Contact | How Can We HELP?

NAIDW: 43912 N. 50th Ln Phoenix, AZ 85087

Telephone: 888.788.NAIDW(6243)

Fax: 623.455.8678

Email: info@naidw.org

Contact Form: Can We HELP?

Cron Job Starts