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Adjuster Certification Test > Common Definitions > Flashcards

Flashcards in Common Definitions Deck (37)
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1

Aggravation (Agg)

actual worsening of the compensable condition or conditions which is established by medical evidence supported by objective findings.

2

Attending physician (AP)

primarily responsible for the treatment of a worker's compensable injury or illness

3

Type A medical provider:

- Med dr
- dr of osteopathic medicine
- podiatric physician and surgeon
- oral surgeon

4

Type B medical provider:

- Chiropractic physician
- physician assistant
- naturopathic physician

5

Authorized nurse practitioner (ANP, or just NP)

authorized to provide compensable medical services

6

Claim

a written request for compensation from a subject worker or someone on the workers behalf or any compensable injury of which a subject employer has notice or knowledge.

7

Combined condition

compensable injury combines qualified preexisting condition to cause or prolong disability or a need for treatment.

8

Come-along provider

A primary care physician, chiropractic physician, or an authorized nurse practitioner who is not a managed care organization (MCO) panel provider and who continues to treat the worker when the worker becomes enrolled in an MCO.

9

Compensable injury

A compensable injury is an accidental injury, or accidental injury to prosthetic appliances, arising out of and in the course of employment requiring medical services or resulting in disability or death. An injury is accidental if the result is an accident, whether or not due to accidental means, if it is established by medical evidence supported by objective findings.

10

Compensation

all benefits, including medical services, provided for a compensable injury to a subject worker or the worker’s beneficiaries by an insurer.

11

Consequential condition

This type of condition occurs as a consequence of a compensable injury.

12

Curative care

stabilize a temporary and acute waxing and waning of symptoms.

13

Disabling injury

- entitles the worker to compensation for disability or death
- An injury is not disabling if no temporary benefits are due and payable, unless there is a reasonable expectation that permanent disability will result from the injury.

14

Elective surgery

may be required in the process of recovery from an injury or illness, but does not need to be done as an emergency to preserve life, function, or health.

15

Impairment

A permanent loss of use or function of a body part or system related to the compensable condition

16

Incarceration

when in pretrial detention or imprisoned following conviction for a crime

17

Initial Claim

first open period on the claim immediately following the original filing of the occupational injury or disease claim until the worker is first declared medically stationary by an attending physician or authorized nurse practitioner.

18

Inpatient

Admitted to a hospital prior to and extending past midnight for treatment and lodging.

19

Managed Care Organization (MCO)

organization formed to provide medical services.

20

Medical services

Any medical treatment or any medical, surgical, diagnostic, chiropractic, dental, hospital, nursing, ambulances, and other related services, and drugs, medicine, crutches and prosthetic appliances, braces and supports and where necessary, physical restorative services.

21

Medically stationary (Med Stat)

No further material improvement is expected with either treatment or the passage of time.

22

New condition

A condition that develops after the notice of acceptance is issued.

23

Nondisabling injury (MO claim)

A nondisabling injury only requires medical services.

24

Objective findings

These are verifiable indications of injury or disease that may include, but are not limited to, range of motion, atrophy, muscle strength, and palpable muscle spasm.

-"Objective findings" does not include physical findings or subjective responses to physical examinations that are not reproducible, measurable, or observable.

25

Occupational disease (OD)

Occupational disease (OD)

26

Omitted condition

A condition that was present at the time the notice of acceptance was issued but was omitted from the notice

27

Palliative care

This is medical service rendered to reduce or moderate temporarily the intensity of an otherwise stable medical condition, but does not include those medical services rendered to diagnose, heal, or permanently alleviate or eliminate a medical condition.

28

Permanent partial disability (PPD)

PPD is the permanent loss of use or function of a body part or system resulting from the compensable injury or occupational disease or permanent impairment and work disability resulting from the compensable injury or occupational disease.

29

Permanent total disability (PTD)

A worker is permanently and totally disabled if permanently incapacitated from regularly performing work in a suitable and gainful occupation

30

Preexisting condition

A preexisting condition is any injury, disease, congenital abnormality, personality disorder, or similar condition that contributes to disability or need for treatment.