Workers’ compensation is a form of no-fault insurance employers provides to their
employees. This coverage provides wage replacement and medical benefits to an employee who is injured or becomes disabled due to employment in substitution for the employee’s right to sue the employer for negligence. Here are some terms you should know if you are dealing with a workers’ compensation claim:
Arising out of and in the course of employment (AOE/COE): Necessary conditions, one of
which must be met to establish a work-connected injury: an injury that “arises out of.”
employment results from a hazard of the employment during an injury “in the course of
employment” occurs at a time, place, and under the circumstances related to the
Average Weekly Wage: An amount used to calculate workers’ compensation benefits equal to
the average amount earned per week by an employee before the injury. Including all overtime,
bonuses, and non-wage allowances such as per-diems and housing.
Beneficiary: An injured employee’s spouse, domestic partner, child, or dependent who is
entitled to receive payments in the event of the death of the employee as a result of work-
related accident or injury.
Claim: A written request by the employee, or on the employee’s behalf, for compensation.
Cumulative injury: Caused by repeated events or exposures at work.
Deferred claim: A claim not yet accepted or denied by the insurance company or self-insured
Deputy Commissioner: An employee of the North Carolina Industrial Commission who makes
decisions about workers’ compensation disputes and approves settlements.
Ergonomics: The study of how to improve the fit between the physical demands of the
workplace and the employees who perform the work.
Family and Medical Leave Act (FMLA): A federal law that provides certain employees with
serious health problems or who need to care for a child or other family member with up to 12
weeks of unpaid, job-protected leave per year.
HIPAA (Health Insurance Portability and Accountability Act): A federal law that ensures
the privacy and security of protected health information and patients’ access to their healthcare records.
Non-disabling claim: A worker’s compensation claim does not result in time lost from employment or permanent disability but only requires medical treatment.
North Carolina Industrial Commission: The administrative body that administers and
enforces workers’ compensation laws in North Carolina.
Occupational disease: A disease or infection arising out of and occurring in the course and
scope of employment.
Occupational Safety and Health Administration (OSHA): The federal agency oversees workplace safety and health in national offices and states without state OSHA programs.
Permanent Partial Disability: Benefits paid to an employee who, as the result of work-related
injury has sustained a permanent disability to a specific body part such as an eye, an ear, an arm, a leg, a hand, or a foot.
Regular work: The job the worker held at the time of injury or a similar position.
Settlement: An agreement between an employee and the insurance company or self-insured
employer about workers' compensation payments and future medical care.
Suspension of benefits: An interruption in paying benefits to an injured employee.
Temporary Partial Disability: Benefits paid to an employee who can do some work while
recovering from a work-related injury but earning less than before being injured because of a
reduced rate of pay or fewer hours worked.
Temporary Total Disability: Benefits paid to an employee who cannot work at all while
recovering from a work-related injury.
Total and Permanent Disability: Benefits paid to an employee for a lifetime when a work-
related injury renders them unable to return to any form of suitable employment.
Worksite modification: Changes to an injured employee’s job, tools, tasks, or worksite to accommodate the employee’s injury-caused limitations.
Contact us today if you have any questions about workers’ compensation.
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