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WORKERS' COMP OVERVIEW

Workers' Compensation Glossary of Terms

Average Weekly Wage (AWW)North Carolina law states that a qualifying worker is entitled to two thirds of their average weekly wage each week. There are different methods by which an insurance company could calculate average weekly wage.

Carrier — The term “carrier” is often the same as “insurer.” It generally refers to any person or fund authorized to insure under worker’s compensation law, and includes self-insurers.

Death Benefits — Benefits a spouse or family member may be eligible to receive if an employee dies as the result of a work-related accident or injury.

Disfigurement — Additional compensation an employee may receive due to scarring or other harm to a person’s appearance.

Injury by Accident — One of the three basic ways a person can become eligible for workers’ compensation. Injury by accident is the interruption of the regular work routine due to an unusual circumstance, such as a construction worker falling off of a roof and injuring his back.

North Carolina Industrial Commission — The administrative body charged with administering and enforcing workers’ compensation laws. It rules on and administers the North Carolina Workers’ Compensation Act as provided for by the North Carolina General Assembly.

Occupational Disease — One of the three basic ways a person can become eligible for workers’ compensation. In addition to what’s specifically listed in the statute, a worker may be able to establish an occupational disease if the worker’s employment was; (1) a significant factor in the disease’s development and; (2) exposed the worker to a greater risk of contracting the disease than the public generally.

Permanent Partial Disability (PPD) — Benefits which employees may be entitled to if they have sustained a permanent disability to certain body parts. Benefits for less than the total loss of a body part are calculated by the treating physician on a percentage basis. This calculation is referred to as a “PPD rating.”

PPD Rating — The percentage of disability an injured person experiences to a specific body part as determined by the treating physician.

South Carolina Workers’ Compensation Commission – The administrative body charged with administering and enforcing workers’ compensation laws. It rules on and administers via Title 42 of the South Carolina Code of Laws.

Specific Traumatic Injury — One of the three basic ways a person can become eligible for workers’ compensation. An exception to the doctrine of injury by accident in which a person can potentially get compensation for performing a normal task, but sustain a neck or back injury in a specific incident that may not be an accident.

Temporary Partial Disability (TPD) — A form of workers’ compensation benefits that employees may be entitled to receive after they have returned to work, but are earning less than they were prior to the injury because of a reduced rate of pay or fewer hours.

Temporary Total Disability (TTD) — Workers’ compensation benefits that may be payable when an employee becomes totally disabled on a temporary basis as a result of workplace activities.

Total and Permanent Disability — Benefits which may be paid to the employee for a lifetime when the employee’s injury renders him or her unable to return to any form of suitable employment.

Vocational Rehabilitation (Voc Rehab.) — Services designed to allow injured employees who cannot return to their former employment to retrain, locate, and obtain suitable employment. These may include (among other things):

  • On-the-job training
  • Transferable skills analysis and testing
  • Resume, interviewing, and job application services
  • Job search assistance
  • Education and tuition payment for retraining

Workers’ Compensation — Workers’ Compensation (also known as Workman’s Comp, Workmen’s Comp, Workers Comp, Workers’ Comp, Work Comp, Worker Comp, or even simply WC) is the legal system that provides monetary and non-monetary benefits as well as medical benefits to qualifying employees who experience work-related injuries or occupational diseases. Workers’ Compensation laws apply to any employer with a minimum number of employees (three in North Carolina and four in South Carolina), subject to limited exceptions.

Medical Terms

ACL — The Anterior Cruciate Ligament (ACL) of the knee. One of two cruciate ligaments (along with the PCL) located in the center of the knee joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are the major stabilizing ligaments of the knee.

Artificial Disc Replacement — In an artificial disc replacement, an injured spinal disc is replaced with an artificial one.

Bulging disc — See “herniated disc”

Chondromalacia — A knee disorder caused by the softening of the articular cartilage (cartilage relating to bones) of the kneecap.

Fusion Surgery (Spinal Fusion) — A back operation in which two or more vertebrae are combined.

Herniated disc — Between each bone in the spine (vertebra) lies a disc made up of cartilage, which cushions against shock and provides flexibility. When a disc ruptures or herniates, its soft jelly-like inner layer leaks out or “bulges” through a weak area in the outer layer. Sometimes the disc will press on nerves in the spinal column, causing pain, tingling, and/or numbness and in some cases, nerve damage.

Laminectomy — A back operation in which the lamina (part of the bony root) of the vertebra is removed or trimmed to create more space for spinal nerves. A common form of this surgery permits the removal or reshaping of the disc.

Lumbar spine — Also known as the “low back” or “lower back.” Injuries to this area can cause radiating pain, tingling, and numbness in the buttocks, legs, and feet, a condition sometimes called sciatica.

MCL — The Medial Collateral Ligament (MCL) of the knee. It spans the distance from the end of the thigh bone to the top of the shin bone and is on the inside of the knee joint. It resists widening of the inside of the joint and prevents “opening-up” of the knee.

Meniscus Injuries — A knee injury. The meniscus is a tough area of cartilage that rests between the knee bones. Their purpose is to distribute the body’s weight evenly across the knee joint. Meniscus tears can cause intense pain and instability (a feeling of “giving way”) in the knee, depending on the severity of the tear.

Micro-discectomy — A back operation in which a small part of the bone over the nerve root and/or disc material from under the nerve root is removed to provide more room for the nerve to heal.

Maximum Medical Improvement (MMI) — The point where a physician determines that an injured worker’s condition can no longer be further improved by medical treatment.

Occupational Rehabilitation See “Vocational Rehabilitation” below.

PCL — The Posterior Cruciate Ligament (PCL) of the knee. One of two cruciate ligaments (along with the ACL) located in the center of the knee joint. The posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) are the major stabilizing ligaments of the knee.

Physical Therapy (PT) — A form of medical treatment designed to help in the recovery from an injury. Some medical records will refer to physical therapy simply as PT.

Ruptured disc — See “herniated disc.”

Sciatica — An injury to the lower back area of the spine which can cause radiating pain, tingling, and numbness in the buttocks, legs, and feet.

Shoulder Dislocation — A shoulder injury that occurs when the head of the humerus (bone in the upper part of the arm) slips out of the shoulder socket.

Slipped disc — See “herniated disc.”

Spinal Disc — Discs made up of cartilage that are located between each bone in the spine (vertebra) that cushion against shock and provide flexibility. It has a strong outer layer and a soft jelly-like inner layer.

Spinal Fusion (Fusion Surgery) — A back operation in which two or more vertebrae are combined.

Torn Rotator Cuff — A shoulder injury in which the rotator cuff is torn. Rotator cuffs are made up of multiple tendons which connect the humerus (bone in the upper part of the arm) to the scapula (shoulder blade).

Vocational Rehabilitation (VR) — Sometimes called “occupational rehabilitation,” a vocational rehabilitation program is intended to help an injured worker return to work in some way after a workplace injury. Vocational rehabilitation may include skill assessments, education, and job search assistance among other features.

North Carolina Industrial Commission Forms

Form 18 — Notice of Accident to Employer and Claim of Employee, Representative or Dependent for Workers’ Compensation Benefits. The official document filed by an employee notifying his/her employer that an injury occurred in the workplace.

Form 24 — Application to Terminate or Suspend Payment of Compensation. The form an insurance carrier must file if it wants to turn off a worker’s weekly check before he or she returns to work.

Form 28T — Notice of Termination of Compensation by Reason of Trial Return to Work. This form certifies that an employee returned to work, even for a brief time. Form 28T may allow the carrier to turn off an injured worker’s NC workers’ compensation checks.

Form 33 — Request for Hearing with the North Carolina Industrial Commission. The form an employee fills out to request a hearing regarding a denied workers’ compensation claim — or to raise other disputes over NC workers’ compensation benefits with the North Carolina Industrial Commission.

Form 60 — Employer’s Admission of Employee’s Right to Compensation. A form that the employer completes to accept the validity of a NC workers’ compensation claim.

Form 61 — Denial of Workers’ Compensation Claim. A form that outlines the reasons that an employer denied an NC workers’ compensation claim.

Form 63 — Notice to Employee of Payment without Prejudice. A provisional acceptance of an NC workers’ compensation claim which the employer’s insurance carrier can later reverse within certain time limitations.

South Carolina Workers’ Compensation Commission Forms

Form 12A First Report of Injury or Illness. This is the claim form for injured workers to fill out to serve notice of an injury and initiate the claim process.

Form 14B Physician’s Statement. This form is filled out by a physician when the worker is determined to have reached Maximum Medical Improvement (MMI).

Form 16A Agreement for Permanent Disability/Disfigurement Compensation. Filling out this form settles a workers’ compensation case, but leaves open the opportunity for an injured worker to reopen the case if his or her condition deteriorates due to the injury.

Form 17 Receipt of Compensation. A form offered by the employer to the injured worker when the employer feels the worker can return to work and has been offered a job within the worker’s restrictions – even if the worker has declined the job. IMPORTANT: Employers may be able to stop weekly checks if the worker signs this form.

Form 19 Status Report and Compensation Receipt. The form filed with the Commission by an employer to end a worker’s case. This form is used whether the worker received benefits or the employer is denying the claim.

Form 20 Statement of Earnings of Injured Employee. This is the form an employer sends to the South Carolina Workers’ Compensation Commission on how much a worker makes and will be paid a week when written out by a doctor.

Form 21 Employer’s Request for Hearing. Allows the employer to request a hearing for a variety of reasons.

Form 50 Employee’s Notice of Claim and/or Request for Hearing. Informs the commission that a worker is making a workers’ compensation claim or, in some cases, requesting a hearing. If an employer is not paying medical expenses or wage benefits, this form would be filed.

If you’re still not sure, don’t hesitate to contact a workers’ compensation lawyer today. And if you have received any of these forms from the workers’ compensation insurance carrier or your employer, you should contact a workers’ compensation lawyer to help ensure your rights are protected. Call anytime at 1-866-900-7078.