Advocate – A person who represents the interests of a party to an injury claim, typically an attorney for an insurance company or an employee. 

Alternate work / light duty / limited duty / modified duty / transitional work – Temporary work or job tasks that are within an injured worker’s doctor recommended physical restrictions, such as no lifting over 20 pounds or no driving. It is a bridge back to full regular job duties. 

Apportionment – The splitting of responsibility between insurers for a claim. 

Claim handler – An insurance company employee who oversees an injury claim. Responsible for initial investigation of a reported injury, payment of benefits, review of medical bills and records, and compliance with state regulations.

Dedicated claim handler – A claim handler who is assigned to handle all injury claims for a specific policyholder. 

Fraud – Any attempt or action by a person to willingly take or receive benefits of any kind that would not otherwise be rewarded to them. 

Gross wages – Total wages earned before taxes are deducted. Multiply total number of hours worked by the hourly pay rate. 

Indemnity – Payment of lost wages to an injured employee while they are out of work due to the injury. 

Independent medical examination – An appointment with an independent medical provider—one not treating the patient for any reason. Often used as a second opinion. 

Loss run – A report of an employer’s claims over policy periods. Typically lists all money spent on each claim as well as claim status. 

Lost time claim – Any claim in which the injured worker has been kept out of work past the state-specified waiting period. 

Managed care – The process to coordinate medical appointments and follow an injured worker’s progress to an early and safe return to work. A nurse case manager typically oversees this process. 
Managed care arrangement
– A decision by an employer to participate in a network of occupational medical providers for treatment of their injured workers. 

Mediation – A negotiation between different parties with the use of an independent person or party overseeing the discussions. 

Medical benefits – Medical treatment for an injured worker, including but not limited to doctor visits, physical therapy and prescriptions. 

Medical fee schedule – State-specific rules or guidelines governing the payment of medical bills in a workers’ compensation case. 

Nurse case manager – A nurse employed by the insurer or their representative to help oversee the medical aspect of a claim. May include reading reports, scheduling doctor visits and attending appointments.   

Return-to-work program – A program put in place by an employer to provide temporary light duty positions to accommodate a worker’s physical limitations as a result of their work injury.

Subrogation – The attempt to hold a third party responsible for a worker’s injury.

Statute of limitations – A period of time after which one is legally unable to proceed with an activity, such as filing a claim or appealing the denial of a claim.  

Vocational rehabilitation – A process to help an injured worker find employment within any work restrictions they may have. Most commonly used when work is no longer available at their employer. 

Wage replacement benefits – Payments made by the insurer to an injured worker to replace lost wages due to time out of work.

Waiting period – The number of days determined by a state that an injured worker must be out of work before qualifying for indemnity (or wage replacement) benefits.