Alphabet Soup

 

If you are dealing with a workers compensation claim you probably feel like you are swimming in alphabet soup. Everything, and I mean EVERYTHING, has an acronym. So here are a few translations, with very basic definitions – hope they help.

 

L&I – Labor & Industries. The Washington State Agency charged with managing workers compensation claims. Often referred to as the Department.

SI or SIE – Self-Insured or Self-Insured Employer. Some employers are self-insured. They must still follow the same law, and the Department has oversight and can help resolve any problems or disputes.

TL – Time Loss. The benefits you receive while you can not work because of your injury.

LEP – Loss of Earning Power Benefits. The benefits you receive if you are able to return to some work, but not at your full earning power. These benefits are paid only while your claim is open.

KOS – Kept on Salary. Some employers may choose to continue your regular pay, and benefits, instead of placing you on time loss (TL) when you can not return to work because of your work injury.

AP – Attending Physician. Your treating medical provider under the claim. You have the right to choose who will treat your work injury, although all providers must have an L&I provider number to bill the Department for treating you.

APF – Activity Prescription Form. The form sent to your medical provider by your claims manger to gather specific information about your condition, treatment plan and work limitations.

MMI – Maximum Medical Improvement. When your medical condition is fixed and stable, and there are no additional curative treatment recommendations.

PPD – Permanent Partial Disability.  The permanent loss of  function or use of  a part of your body because of your injury. Called a ‘partial’ disability because you are able to return to some type of gainful employment.

PTD –Permanent Total Disability or Pension. The inability to return to reasonable continuous gainful employment in any capacity because of your work injury.

CM- Claims Manager. The person in charge of managing the day to day activities on your claim.

TPA – Third Party Administrator. If your employer is self-insured your claim may be managed by a third party, or private company, hired to manage claims.

VRC- Vocational Rehabilitation Counselor. The professional assigned to assist with early return to work, assess your ability to return to work when your medical condition stabilizes, and to assist with vocational retraining if you are found eligible.

VDRO – Vocational Dispute Resolution Office. The section of the Department in charge of resolving disputes about employability determinations or vocational services.

IME – Independent Medical Exam.  A medical exam done at the request of your claims manager. (We’ll debate another time whether these are truly “independent”)

DO – Department Order. The notice you receive from the department when they take action on your claim, including payment of benefits. Watch carefully, if you disagree with this order you have 60 days to file a written protest or appeal.

BIIA – Board of Industrial Insurance Appeals. The State agency charged with holding hearings to resolve dispute in a Labor & Industries Claim.

IAJ – Industrial Appeals Judge. Hearings are conducted by an Industrial Appeals Judge.

AAG – Assistant Attorney General. The attorney who represents the Department, and defends the Department orders in litigation.

 

If you are in the Longshore Arena you may run into some different initials:

 

OWCP – Office of Workers Compensation Programs. A subpart of the Federal Department of Labor, which has oversight of Longshore claims

TTD – Temporary Total Disability. Similar to time loss, the wage replacement benefit you receive while you unable to work because of your work injury.

TPD – Temporary Partial Disability benefits. Similar to Loss of Earning Power, the benefits you receive if you are able to return to some work, but not at your full earning power. Paid until your medical condition is stable.

AWW- Average Weekly Wage. The base rate used to determine the amount of your weekly benefits.

ALJ – Administrative Law Judge. Longshore hearings are conducted by Administrative Law Judges.

2 thoughts on “Alphabet Soup

  1. I’ve been on l&i since 10/05/2014 I got hurt at work transferring a resident. They first said I had a herniated disc and after a long time had surgery, it only helped the pain in my left leg and the numbness. It did nothing for the pain in my back. Then after talking to dr explaining again we’re my pain was still he said it may of been a Si Joint issue? So he got it approved for a shot in my left si Joint. He said this is how they diagnosis this Si Joint issue. I had the shot and omg it helped. I mean like all this time I stopped doing everything cooking, cleaning, I stayed in bed all the time cause I was always in pain. I gained a lot of weight. I know that I willl probably always have pain and I do but I I’m at least happy to not be in that pain, and told be out of bed. Now I am scheduled to have a shot on other side. K so now they are wanting to close my claim. I had a ime done they said I was a category 2?? What does this mean? And what’s next??

    • I’ll answer the easy question first. A Category 2 for low back impairment is 5% of TBI (total body impairment) the dollar value is determined based on the date of injury. Using 10/5/14 as your date of injury – the Category 2 rating would entitle you to an award of $9,855.54.

      ‘What’s next’ is a more complicated question. Does your doctor agree with the Category 2 rating? Is there additional treatment being recommended? Have you returned to work? Has an Ability to Work Assessment been done? Have you been found employable? Can that determination still be disputed? Your claim could go a variety of directions depending on these (and other) questions. More importantly – ask yourself, “what’s next?”. Do you want to return to some type of work? Can you afford not to work? What do you want this next stage of your life to look like? It is a constant challenge for injured workers to remember to take control of their own lives. An attorney can help make sure you get the benefits you are entitled to receive – but you’re the only one in control of your life.

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