- Workers' Compensation
- A state-mandated insurance system that provides medical care and wage-replacement benefits to employees who are injured or become ill because of their job, regardless of who was at fault. In exchange, the employee generally gives up the right to sue the employer for the injury.
- Adjuster
- A licensed professional who investigates a workers' compensation claim, determines whether it is covered, evaluates the benefits owed, and manages the claim through resolution. The adjuster acts on behalf of the insurer or self-insured employer.
- Indemnity Benefits
- Cash payments made to an injured worker to replace lost wages while they are unable to work, as opposed to payments for medical treatment. They are typically calculated as a percentage of the worker's average weekly wage.
- Average Weekly Wage (AWW)
- The worker's typical earnings per week before the injury, used as the baseline for calculating indemnity benefit amounts. It is usually derived from wages earned over a defined period prior to the date of injury.
- Temporary Total Disability (TTD)
- A benefit paid when an injured worker is temporarily unable to work at all while recovering. Payments continue until the worker returns to work or reaches maximum medical improvement.
- Permanent Partial Disability (PPD)
- A benefit paid when a work injury leaves the worker with a lasting impairment that only partially limits their ability to work or function. The award is often tied to an impairment rating.
- Maximum Medical Improvement (MMI)
- The point at which an injured worker's condition has stabilized and is not expected to improve further with additional treatment. MMI is a key milestone for evaluating permanent impairment and future benefits.
- Impairment Rating
- A percentage assigned by a physician that reflects the degree of permanent loss of function resulting from a work injury. It is used to calculate the value of permanent disability benefits.
- Subrogation
- The insurer's right to recover benefits it paid on a claim from a negligent third party who actually caused the worker's injury. It prevents the injured worker from collecting twice for the same loss.
- Compensability
- The determination of whether an injury or illness arose out of and in the course of employment and therefore qualifies for workers' compensation benefits. A non-compensable claim is one the insurer is not obligated to pay.
- Independent Medical Examination (IME)
- An evaluation performed by a physician who is not the treating doctor, used to obtain an objective opinion on the worker's condition, treatment, or impairment. It is often requested when there is a dispute about the claim.
- Reserves
- The amount of money an insurer sets aside on a claim to cover the estimated future cost of medical care and indemnity benefits. Setting accurate reserves is a core adjuster responsibility.