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| An unexpected happening, causing injury traceable to a definite time and place |
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| The final determination of the issues involving settlement of an insurance claim also known as a claim settlement |
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| A report must be submitted with the claim when the notation "BR" follows the procedure code description. This term is sometimes seen in worker's compensation fee schedules. |
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| In industrial cases, a represetnative of the insurer who authorizes treatment and investigates, evaluates and negotiates the patients insurance claim and acts for the company in the settlement of claims; also known as claims adjuster, claims representative, and claims adminstrator. |
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| An agreement arrived at,whether in or out of court, for settling a worker's compensation case after the patient has been declared permanent and stationary. |
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| The process of taking sworn testimony from a witness out of court. This is usually done by attorney. |
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| Science and technology that seek to fit the anatomic and physical needs of the worker to the workplace. |
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| state laws effective outside the state by either specific provision or court decision. |
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| Federal Employees Compensation Act (FECA) |
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| An act instituted in 1908 providing benefits for on-the-job injuries to all federal employees |
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| a list of charges or established allowances for specific medical services and procedures |
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| any trauma or damage to a body part or disease sustained, arising out of, and in the course of employment, including injury to the artificial members and medical braces of all types. |
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| an individual at the workers compensation insurance carrier overseeing an industrial case, authorizing diagnostic testing and medical treatment, and communicating with the physician out of any proceeds received on the case. |
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| a claim on the property of another as a security for debt. |
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| an authorization given to the physician, whether written or verbal to treat the injured or ill employee. |
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| on-the-job injury that requires medical care but does not result in loss of working time or income. |
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| Permanent Disability (PD) |
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| an illness or injury expected to continue for the lifetime of the injured worker that prevents the person from performing the functions of his or her regular occupation, therefore impairing his or her earning capacity. |
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| a formal written request commonly used to indicate an appeal; also means any request for relief other than an application. |
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| videotapes made without the knowledge of the suject; used to investigate suspecious claims in workers compensation cases |
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| Temporary Disability (TD) |
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| the recovery period after a work related injury during which the employee is unable to work and the condition has not stabilized; a schedule of benefits payable for the temporary disability. |
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| exists if an entity is liable to pay the medical cost for injury disease, or disability of a person hurt during the performance of his or her occupation and the injury is caused by the entity not connected with the employer. |
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| the legal process by which an insurance company seeks from a third part, who has caused a loss,recovery of the amount paid to the policyholder. |
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| for disablity insurance the initial period of time when a disabled individual is not eligable to receive benefits even though unable to work; for workers compensation, the days that must elapse before workers compensation weekly benefits become payable. |
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| individualized program of therapy using simulated or real job duties to build up strength and improve the worker's endurance to be able to work up to 8 hours a day. |
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| Workers' Compensation Appeals Board (WCAB) |
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| the board that handles workers' compensation liens and appeals. |
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| Workers' Compensation (WC)Insurance |
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| a contract that insures s person against on-the-job injury or illness. The employer pays the premium for his or her employees. |
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| the dollars and cents amount that is established for one unit as applie to the procedure or service rendered. The unit is the use to convert various procedures into fee-schedule payment amounts by multiplying the relative value unit by the conversion factor. |
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| anesthesia is accomplishe by insertion of a tube into the nose or mouth, and passing the tube into the trachea for ventilation |
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| induction or administration of a drug to obtain a partial or complete loss of sensation |
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| a state of unconsciousness that is accomplished by the use of a drug or combination of drugs administered intramuscularly, rectally, intravenously or by inhalation. |
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| five digit CPT codes that describe situations or conditions that affect the administration of anesthesia. |
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| modifying units in the Anesthia section of the CPT manual that describe a patient's condition at the time anestesia is administered |
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| tumor, mass, fluid collection |
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| tension, spasm, contraction |
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