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Glossary of WCB Terms

Glossary of Workers' Compensation Terms

AASCIF
See American Association of State Compensation Insurance Funds
Abey (a Case)
(WCB Claims) To assign to a claim a future date at which time the claim will be re-examined, to allow time for receipt of information needed to proceed. In the Claims Information System (CIS), claims are abeyed automatically at certain stages of processing.
Abey (a Case)
(Compliance) - To delay further action in order to give an entity (usually an Employer) time to respond to a request for information.
Abey an Issue
To postpone a decision on an issue in a case until a later date, when it is expected than additional pertinent information may or will be available.
ACCES-VR
Adult Career and Continuing Education Services-Vocational Rehabilitation
Accident Date
(WCB) - Refers either to (a) the date the accident is deemed to have occurred, or (b) the date of onset assigned to an occupational disease.
Accident Description
Text that relates and describes an accident, often segmented into sections that respond to a series of questions about the accident.
Accident Time in Shift
Time when accident occurred, relative to beginning of injured worker's shift.
Accident Time of Day
Time of day when accident occurred.
Accident Type
(ANSI) - Numeric coding structure (3-digit, about 90 codes) used to describe the manner in which injury or illness was produced or inflicted by the Source of Injury. {Examples: Overexertion in lifting object or objects = 121; Struck by flying object = 022} In the OSH system, the Accident Type structure is replaced by the very similar Event or Exposure classification.
Accident (Work-Related)
(WCB) An event, arising out of and in the course of employment, that results in personal injury to a worker.
Accident, Notice and Causal Relationship (ANCR)
(WCB) - Minimal conditions that must be met before financial responsibility can be assigned to a claim for workers' compensation. Specifically, it must be established that (a) a work-related accident covered by the Workers' Compensation Law has occurred; (b) following the accident, the Claimant has notified her/his employer within the time limit required by the Workers' Compensation Law; and (c) a causal relationship exists between the accident and the resulting injury or disability.
Acknowledgement Record
An acknowledgment record is an electronic reply sent by the WCB for a First Report of Injury (FROI) or Subsequent Report of Injury (SROI) that was received by the Board. The acknowledgment record will indicate if the FROI or SROI was accepted or rejected. It will provide the Jurisdiction Case Number (JCN) to the claim administrator for FROIs and SROIs that are accepted. When a transaction is rejected, the acknowledgment record will provide the reasons for the rejection. Flat file submitters will receive an acknowledgment record via flat file. Web submitters will receive an acknowledgement record via an immediate confirmation message.
ACOE
See Arising out of and in the Course of Employment
Acquired Claim
An acquired claim is a claim that was previously administered by a different claim administrator. The acquisition of a claim is a claim event that must be reported to the WCB.
Active Penalty
(Compliance) - A penalty that can be collected.
Adjourn (a Hearing)
(WCB) - To put off or suspend until a future time, without issuing a decision.
Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR)
A unit of the New York State Education Department which evaluates vocational rehabilitation needs and sometimes provides vocational rehabilitation services to (among other groups) referred workers' compensation claimants.
Advance of Periodic Payments of Compensation
Claimant gives indication that they need an advance of payments that are due to them.
Age at Injury
Claimant's age on the date of accident or the onset of Occupational Disease (as officially established by the WCB).
Agent
(Compliance) - Person authorized to underwrite insurance policies for specific carriers.
Aggregate Trust Fund
(WCB) - A trust fund established under Section 27 of the Workers' Compensation Law to assure the payment of workers' compensation in claims involving death, permanent total disability, and the loss of major members. In the case types above, a private carrier is required and, under certain circumstances, a self-insured employer is permitted to pay the actuarial value of a claimant's future compensation payments into the fund. Upon such payment, the Carrier and the Self-Insured Employer are discharged from future liability to the Claimant for compensation or death benefits.
AIA
See American Insurance Association
AKA or a/k/a
Abbreviation for "also known as"
Amenable
(Compliance) - Subject, as in "The Employer is subject (or amenable) to the requirement to maintain Workers' Compensation Insurance."
American Association of State Compensation Insurance Funds (AASCIF)
An association of state and provincial agencies that issue workers' compensation insurance in the United States and Canada. The Association's goals include the exchange of information, experience, and expertise among the member funds.
American Insurance Association (AIA)
An insurance industry trade organization; historically, the AIA has taken an active interest in government affairs and legislative issues.
American National Standards Institute (ANSI)
A private organization concerned with establishing specifications and standards that enhance interoperability, compatibility, and communications. The term ANSI also refers to specific standards endorsed by the organization.
ANCR
See Accident, Notice and Causal Relationship
Annual Average Work Force
(DOL Abbrev.) - The average (not total) number of full-time and part-time employees who work at a particular establishment during the calendar year.
ANSI
See American National Standards Institute
AOS
See Associated Object or Substance
Appeal
(WCB) - A legal action taken by one of the parties in the Appellate Division, Third Department, to reverse or amend a decision or direction made by a Board Panel or the Chair of the Workers' Compensation Board.
Apportionment
(WCB) - A proportionate division of all or part of the benefit costs in a case between two or more injury claims for the same claimant, based on an evaluation of the relative contribution that the injuries have made to the claimant's permanent disability.
Arising Out of and In the Course of Employment (ACOE)
(WCB) - Two necessary conditions that must be met to establish a work-connected accidental injury. An injury that "arises out of" is one that results from a hazard of the employment, while an injury "in the course of employment" is one that occurred at a time, place, and under circumstances related to the employment.
Assembled Case
A case which has the minimum required information of: claimant name and address, employer name and address, and an indication of a work-related injury or illness.
Associated Object or Substance (AOS)
(ANSI) - Numeric coding structure (4-digit, with 400+ codes) used to identify accident-causing hazards--objects, substances, or people, with respect to which measures could have been introduced to prevent the accident or mitigate the injury or illness (Example: Tunnels = 1640; a majority of the other ANSI AOS codes are the same as the ANSI Source of Injury codes). In the OSH system, the Associated Object or Substance coding structure is replaced with a proposed Secondary Source of Injury/Illness structure.
Association
(Compliance) - An unincorporated organization of people having a common interest.
ATF
See Aggregate Trust Fund
Attachment
Any document that is not a WCB form and that arrives together with a WCB form.
Attorney Fees (Claimant's)
(WCB) - Fees approved by the WCB for claimant attorneys in workers' compensation cases. Under Section 24 of the Workers' Compensation Law, no claims for services or supplies are enforceable unless approved by the Board, and, if approved, such claims become a lien upon the compensation awarded.
Average Lost Workdays per Lost Workday Cases
(DOL) - The number of workdays lost, divided by the total number of lost workday cases.
Average Weekly Wage (AWW)
(WCB) - Wage used to calculate total disability benefit rates for most claimants defined as 1/52nd of the Injured Worker's average annual earnings (200-300 times average daily wage, depending on work schedule), based on the prior year's payroll data. If the Injured Worker did not work a substantial portion of the immediately preceding year, the average wage of a comparably employed worker is used in the Board's calculations.
AWW
See Average Weekly Wage
Benefit Mortality
Termination of long-term benefits (e.g., permanent total disability, nonscheduled permanent partial disability, death benefits) generally is due to (a) Claimant's/Recipient's death; (b) lump-sum settlement; (c) Claimant's return to full-time employment; (d) loss of eligibility (e.g., remarriage of widow/widower). Anticipated benefit mortality rates (mortalities per year) affect the present value of such benefits.
Benefit Type Code (BTC)
A code that identifies the benefit being paid by the Claim Administrator (i.e. 050 – Temporary Total). BTCs accepted by the WCB are summarized on the Quick Code Reference List.
BLS
See Bureau of Labor Statistics
Board Customer
Claimant and/or Employer, formerly referred to as Party of Interest (POI).
Board Panel
(WCB) - A panel, usually comprised of three Workers' Compensation Board members (at least one of whom must be a lawyer), that reviews requests to amend decisions made by Workers' Compensation Law Judges.
Broker
Person who arranges the purchase of insurance policies.
BTC
See Benefit Type Code
Bureau of Labor Statistics (BLS)
Division within United States Department of Labor most directly involved with collecting and disseminating data regarding workers' compensation and workplace safety.
C-11
A WCB form titled "Employer's Report of Injured Employee's Change in Employment Status Resulting from Injury" that the Employer files as soon as there is a change in employment status (return to work, discontinuance of work, increase/decrease in regular work hours, increase/reduction in wages) from a previous First Report of Injury or C-11. The form includes (a) information identifying the claim, injured person, employer, and carrier; (b) date of most recent employer's report, start of disability date (and nature of injury), and date of first return to work; (c) summaries of change in employment status and of lost time; and (4) current medical status of claimant, or death date and name and address of nearest relative.
C-2F
A WCB form titled "Employer's First Report of Work-Related Injury/Illness" that is normally filed by an employer within 10 days after occurrence of Injury/Illness, as required by Section 110 of the Workers' Compensation Law. Submission of this form to the Board by the Employer is not required if the insurance carrier will be electronically submitting the information on their behalf through a FROI transaction.
C-240
A WCB form titled "Employer's Statement of Wage Earnings (Preceding the Date of Accident)" which includes (in addition to case identification information) a summary of gross weekly earnings for the 52 weeks immediately preceding the date of accident for either the injured Employee or, if the Employee did not work a full year prior to the accident, a worker in the same class as the injured Employee. The C-240 form often is used by the Board in establishing the Claimant's average weekly wage.
C-3
A WCB form titled "Employee Claim" that should be completed by the injured Worker and submitted to the Board within two years of the accident, or within two years after employee knew or should have known that injury or illness was related to employment.
C-4
A WCB form titled "Doctor's Initial Report" that requests information from the physician about the claimant’s initial visit/rendering of treatment. The form must be filed by the Doctor within two days of initial treatment.
C-4.2
A WCB form titled “Doctor’s Progress Report” that requests information from the physician about follow-up visits and continuing services provided to the claimant. Following the filing of Form C-4, Doctor’s Initial Report, this form should be filed at 45 day intervals during continued treatment, unless change in condition necessitates additional reporting.
C-4.3
A WCB form titled “Doctor’s Report of MMI/Permanent Impairment” that requests information from the physician when a patient/claimant has reached Maximum Medical Improvement and to render an opinion on permanent impairment, if any.
C-4AUTH
A WCB form titled “Attending Doctor’s Request for Authorization” used to confirm a telephone request for written authorization for special service(s) costing over $1,000 in a non-emergency situation.
C-669 (obsolete form)
A form that was previously utilized by Claim Administrators to indicate they were accepting a claim. The form included: (a) information identifying the claim, injured person, employer and carrier; (b) a brief diagnosis of the injury and town/county/state where injury occurred; (c) a summary of payment start dates and benefit rate, including the basis for computing the latter; and (d) dates for start of disability, first knowledge of injury, receipt of a First Report of Injury from the Employer, mailing of first payment, and payee if different from the injured person. Effective 5/23/14, form C-669 is no longer an acceptable filing and the Claim Administrator must file the appropriate FROI/SROI.
C-7 (obsolete form)
A form that was previously utilized by Claim Administrators to controvert (deny) a claim. The form included (a) information identifying the claim, person (allegedly) injured, employer; and carrier; (b) diagnosis of alleged injury and town/county/state where alleged injury occurred; (c) reasons why right to compensation is controverted; (d) dates for start of alleged disability, employer/carrier first knowledge of injury, receipt of a First Report of Injury from the Employer; and (e) statement concerning whether notification has been given to the disability benefits insurance Carrier, and date of notification. Effective 5/23/14, form C-7 is no longer an acceptable filing and the Claim Administrator must file the appropriate FROI/SROI.
C-71
An internal WCB form titled "Report of Medical Examination" that is completed by a Compensation Examining Physician or Medical Specialist and submitted under oath. Other than sections identifying the case, Claimant and Employer, the report consists of a narrative describing the examination's findings.
C-8/8.6 (Obsolete Form)
A form that was previously utilized by Claim Administrators to show payments on a claim. The form included: (a) information identifying the claim, injured Person, Employer and Carrier; (b) a summary of total disability benefits, partial disability benefits and disfigurement awards paid; (c) a summary of the Claimant's return-to-work and earnings status; and (d) if appropriate, an explanation of why disability benefits had not been paid in full. Depending on circumstances cited by the Carrier and the Claimant's response, the filing of a C-8/8.6 may or may not have triggered an immediate hearing. Effective 5/23/14, form C-8/8.6 is no longer an acceptable filing and the Claim Administrator must file the appropriate SROI.
C-8.1
A WCB form titled “Notice of Treatment Issue/Disputed Bill” submitted by an Insurance Carrier/Board approved self-insurer within 5 days after terminating medical care (Part A) or refusing authorization or objecting to payment of a bill within 45 days of submission of bill for treatment provided (Part B).
C-8.4
A WCB form titled “Notice to Health Care Provider and Injured Worker of a Carrier’s Refusal to Pay All (or a Portion of) a Medical Bill Due to Valuation Objection(s)” submitted by an Insurance Carrier/Self-Insured Employer within 45 days after a bill is submitted. This form was designed specifically to provide carriers with a useful format for the notification of valuation objections. The use of this form is not required but is encouraged.
Calendar
A list of the cases scheduled to be heard on a given date at a specific part at a district office or hearing point.
Cancel (a Case)
(WCB) - An action by the Workers' Compensation Board to nullify indexing when two case numbers are assigned to a single claim.
Carcode
See Carrier Code
Carrier
Insurance company that issues policies (for Workers' Compensation or Disability Benefits).
Carrier Catastrophe Number
A sequential number (beginning with 1) assigned by carriers to catastrophes (any accident resulting in two or more reported claims) occurring under a particular policy.
Carrier Code
The ten-character code that identifies a specific insurance carrier. W is always the first character in the code for a carrier of Workers' Compensation policies. The codes for carriers of Disability Benefits insurance always begins with the letter B. Carrier codes are issued by the Finance Office of the WCB.
Case
(WCB) A reported work injury or illness which has been assembled and assigned a case number by the Workers' Compensation Board.
Case
(DOL) A work-related incidence of injury or illness which must be entered on the New York State Department of Labor Log and Summary of Occupational Injuries and Illnesses.
Case Number
(WCB) The case number structure is eight characters beginning with an alpha character, followed by seven numeric characters. For example, G1234567.
  • Volunteer ambulance workers’ cases begin with AA, followed by six numbers (e.g. AA123456).
  • Volunteer firefighters’ cases begin with FA, followed by six numbers (e.g. FA123456).
The WCB case number does not designate the district or year the case was created. For eClaims purposes the JCN is the WCB case number.
Catastrophe
(CIRB, Carriers) - Any single accident resulting in two or more reported claims.
Cause of Accident
Hazardous object, substance or condition that directly contributed to the occurrence of an accident.
Cause of Accident
(CIRB) - A numeric coding structure (2 digit, with 54 codes) used to describe the work accident. It is similar to (but less detailed than) both the (ANSI) Accident Type codes and the (OSH) Event or Exposure codes. {Examples: 29=Fall or Slip Injury, On Same Level; 45=Motor Vehicle - Collision with another Vehicle}.
CCC
See Compensated Cases Closed
CCR
See Compensated Cases Reclosed
Census of Fatal Occupational Injuries (CFOI)
(BLS) - A national data program, sponsored by the Bureau of Labor Statistics, intended to collect information on all fatal occupational injuries that occur each year. Data for the program is drawn from a variety of information sources (OSHA reports, workers' compensation reports/claims, death certificates, etc.).
CFOI
See Census of Fatal Occupational Injuries
CIRB
See New York Compensation Insurance Rating Board
CIS
See Claims Information System
CL
(Compliance) - Abbreviation for Continuous Lapse, a continuing (open) period during which an employer does not have Workers' Compensation or Disability Benefits insurance, and is therefore out of compliance with Workers' Compensation Law
Claim
(WCB) - A request on a prescribed form C-3 for workers' compensation for work-connected injury, occupational disease disablement, or for death (form C-62) resulting from either cause. A claimant must file a claim within a two-year period from the occurrence of the accidental injury, knowledge of occupational disablement, or death. Failure to file a claim may bar an award for compensation unless the Employer has made advance benefit payment, in which event the claim filing requirement is waived.
Claim
(CIRB, Carriers) - A demand for payment or recovery for loss under an insurance contract. Cases are counted as claims only when a payment is made or a reserve is established.
Claim Administrator
(eClaims) - The claim administrator is the organization that administers a Workers’ Compensation claim. A claim administrator can be an insurer, a licensed third party administrator, a self-insured employer, a self-insured group trust or a guarantee fund.
Claim Event
A claim event is a business circumstance in the life of a claim that must be reported to the WCB. Examples of claim events are changes in data elements, payment of awards, and suspension of payments to a claimant.
Claim Event Table
The Claim Event Table details the claim events that must be reported to the WCB. It provides the timeframes for reporting these claim events and the Maintenance Type Codes (MTC) that are expected.
Claim Frequency
(CIRB) - A measure of the number of claims relative to an exposure base (e.g., payroll, number of employees).
Claim Number
(CIRB, Carriers) - An alphanumeric string identifier assigned by a carrier to a claim for their own records and in reports to ratemaking organizations (e.g., the CIRB).
Claim Severity (or Claim Cost)
(CIRB) - A measure of the cost of workers' compensation claims, often expressed as an average cost per claim.
Claims Information System
(WCB) (Abbrev. CIS) - A data system used by the Board's Claims Unit to record basic case information, claim parties of interest, current issues, scheduled hearings, etc.. Historically, it has been utilized in calendaring of cases (i.e., establishing hearing schedules) and in case identification.
Claim Type Code
A code on the FROI or SROI report that identifies the current status of the claim (ie. M – Medical Only). Claim Type Codes are summarized on the Quick Code Reference List.
Class Rating
A method for determining an employer's workers' compensation premiums based on the class(es) included in the employer's payroll and the manual rate schedule for the state.
Classification Code
(NCCI, CIRB) - A system of insurance risk classification based on industrial or occupational categories, supported by the National Council on Compensation Insurance and in use in about 40 states where private insurance is available. The system, which includes several thousand four-digit numeric codes (with more than 700 work classifications in use in New York and most states), is extensively used to identify an employer's ratemaking class(es) and establish basic pricing for workers' compensation insurance.
Common Employer Database (CED)
(Compliance, IC2) - Database where records containing all employer information for the Workers’ Compensation Board (WCB) are stored. The records stored here are the source of employer information for all Compliance units at the Board, and for all IC2 system users. Eventually, many of the Board’s other electronic systems (including CIS and HPA) will rely on this database as well.
Compensated Cases Closed (CCC)
A data system of the Workers' Compensation Board used to summarize WCB cases having their initial closing with indemnity benefits during a particular calendar year. The annual files generally contain 120,000-140,000 case records and include information about case/claimant background, employment, injury/accident characteristics, extent of disability, indemnity benefits and selected decision characteristics.
Compensated Cases Reclosed (CCR)
A data system of the Workers' Compensation Board used to summarize reclosings that indicate indemnity award changes to cases already included in the Compensated Cases Closed (CCC). The intent of this reclosing system is to show changes in disability classification and indemnity awards to CCC cases. The annual files contain 6,000-10,000 case records and include information about each case's initial compensated closing, most recent prior closing, and current closing (dates, extents of disability), along with indemnity award additions/modifications and flags for third- party settlements and apportioned awards.
Complete Case
A case which has a C-2F, C-3, or FROI plus a C-4 or equivalents present.
Compliance
The function of ensuring that all employers required to do so carry workers’ compensation or disability benefits insurance coverage.
Conciliation Process
(WCB) - The conciliation process permits claims to be handled, in an expeditious and informal manner (e.g., through meetings or telephone conferences), issues involving non-controverted claims where the expected duration of benefits is 52 weeks or less. Each claim that is filed shall be reviewed for possible transfer for conciliation. Failure to reach an agreement through the conciliation process results in the case being scheduled for a hearing.
Concurrent Employment
Employment of one worker in more than one job during the same period.
Consequential Accident
(WCB) - A second accident resulting from a prior accidental injury which arose out of and in the course of employment; e.g., a claimant who falls down a flight of stairs at home while using crutches because of a leg injury incurred at work.
Continue (a Case)
(WCB) - To complete a hearing on a case without closing the case, leaving additional matters to be resolved at a future hearing.
Controverted Claim
(WCB) - A claim challenged by the Carrier on stated ground. A pre-hearing conference is set by the Board, and the parties are directed to appear and present their case.
Conversion Documents
Compliance/DB scanning prep) - Groups of papers that have already been processed and are being stored. These documents will be used in the future; therefore they need to be converted to electronic images. (Stored and processed documents that will probably never be referred to should not be converted.)
Corp.
A legal entity registered with the NYS Department of State, with its own rights and responsibilities. Corp., Inc., PC (Professional Corporation), and Ltd (Limited) are abbreviations for types of corporations. SA is an abbreviation for a French or Spanish corporation.
Coverage
(Compliance) - Insurance policy in effect for a specific period of time.
Coverage Manual Posting (CMP)
(Compliance, IC2) - Insurer-submitted transactions that could not be processed through batch programming and require a person to decide where the coverage should be posted. The two types of CMPs are employer and transaction.
Credibility
(NCCI,CIRB,SIF) - A level of confidence (e.g., "20% credible") assigned to loss-experience data, generally reflecting a statistical model for combining loss experience from two or more sources. Credibility-weighting is widely used in many lines of insurance when there is insufficient data to establish rates based solely on a group's or policyholder's experience. In workers' compensation underwriting, it is used in establishing experience ratings--weighting an employer's data with loss data for their insurance class (e.g., same manual rate class). {Example: An employer's loss experience shows half the losses of other employers in the same class, and the employer's data is 20% credible. Based on the information for this simplified illustration, credibility-weighted loss experience for the employer would be (20%) x (1/2) [employer’s data] + (80%) [classes’ data] x 1 = .90 ["experience rate"]}
Crisis Response Team
A group of designated employees who are mobilized to respond to serious incidents that could impact the safety of persons at the Board. Each District Office has a local CRT; the agency CRT is in the central office.
CRNYC
Credit New York City
CRNYS
Credit New York State
Crosswalk
A program or algorithm for translating or partially translating data from one coding structure to another--for example, from NCCI Classification Codes to SIC codes.
Data Administrator (DA)
(Compliance) - IC2 system user in Employer Coverage, Disability Benefits, No-Insurance, Enforcement, or Self Insurance who is responsible for maintaining the integrity of the Common Employer Database (CED).
Data Call
A data call is a specific request for claim information that is made by the WCB to a Claim administrator. HOME
Data Element (DN)
A data element is a single piece of defined information within a transaction. Every data element is assigned a reference number and has a prescribed format. Some data elements must be sent using certain defined values. An example is Accident Premises Code – DN0249. Data elements are defined in the IAIABC Implementation Guide.
Data Element Requirement Table
The Data Element Requirement Table details the data elements that must be reported to the WCB. It indicates which data elements must be reported and details the conditions under which the data elements are required.
DBA or d/b/a
Doing business as
Denial
Full denial of a workers’ compensation claim by the Claim Administrator. A Claim Administrator may file a FROI 04 or SROI 04 transaction indicating the claim is denied in its entirety. Upon implementation of eClaims for a Claim Administrator this will be the only acceptable full denial of a claim.
Dependent (in a Death Case)
(WCB) A person eligible to receive death benefits in a fatal injury case. The regular receipt of contributions by the alleged dependent upon which s/he relies and needs to sustain her/his customary mode of living constitutes dependency. Surviving spouses and children under age 18 years are eligible for benefits without proving dependency, and other eligible recipients (if dependency is established) may include dependent handicapped children over age 18 years, grandchildren, brothers and sisters under age 18, dependent parents, and grandparents.
Disability Benefits Law
Article 9 of the Workers' Compensation Law provides for the payment of benefits to persons out of work because of illness, pregnancy, or disabling accidents not connected with their employment. {The Workers' Compensation Board also is the agency responsible for administration of the Disability Benefits Law.}
Division of Safety and Health (DOSH)
Unit of the New York State Department of Labor which provides licensing, training, and consultation services in addition to code enforcement in areas of occupational safety and health not covered by OSHA. Specific areas of emphasis within DOSH include boiler safety, asbestos control, radiological health, on-site consultation for private employers, mine safety and health, public employees’ safety and health, industry inspection, engineering services, and training and education.
DN
(Compliance) Dunning notice
DN
(eClaims) - See Data Element
Document
(Scanning prep) - A related group of one or more papers, all of which will be scanned to produce a single electronic document. For example, a letter on four pieces of paper (with information written on the front and back of each paper) is one document, because all four papers will be kept together all the time. When you look at the scanned front of the first page on the screen and press the ‘next’ button, you see the back of the first piece of paper. If you press the ‘next’ button again, you will see the front of the second piece of paper.
DOL
New York State Department of Labor
Dole v. Dow Chemical Company
A product liability lawsuit which led to a landmark 1972 decision by the New York Court of Appeals that permits lawsuits against employers by defendants in third party liability cases. Dole, an employee, died while cleaning an employer's storage bin which had been fumigated with a chemical manufactured by Dow. Dole's widow sued Dow; Dow in turn sued Dole's employer, alleging that the employer had been actively negligent (improper precautions, untrained fumigation staff, failure to follow instructions, failure to test bin, etc.) and, therefore, Dow contended, the employer should be required to indemnify Dow in the event of a finding favoring Dole's widow. The Court of Appeals ruled (in effect) that an apportionment of responsibility and liability, based on relative culpability of the manufacturer and employer, would be based on a breach of an independent duty or obligation by the employer, and Dow's suit against the employer was therefore not inconsistent with the exclusiveness of remedy provisions of the Worker's Compensation Law. The Court of Appeals finding was codified into law by the New York Legislature in 1974. Currently, New York is the only state whose statutes recognize an employer's apportioned liability based on third-party lawsuits stemming from workers' compensation cases.
DOSH
See Division of Safety and Health
Double Compensation - (Also Double Indemnity)
(WCB) - A duplicate award of either compensation or death benefits made on the grounds that the injured Worker, at the time of the accident, was under the age of 18 years and was permitted or suffered to work in violation of the New York Labor Law. The Employer alone and not the Insurance Carrier is liable for the additional compensation.
Double Indemnity
See Double Compensation
D&A
See Decision and Award Data System
D&B
Dun & Bradstreet, a credit reporting and collection agency
D.A.
1. District Administrator, q.v. 2. (Compliance) - Data Administrator, q.v.
Earning Capacity
(WCB) - The ability of a claimant (i.e., one who has suffered a work-connected disabling injury) to earn wages in the labor market. A claimant's earning capacity is determined by actual post-accident earning, or, in the absence of such earnings, a theoretic wage-earning capacity may be established by the Workers' Compensation Board.
eClaims
the New York State Workers’ Compensation Board’s implementation of an electronic claim reporting standard for reports of injury filings. The WCB has adopted a national standard for claims reporting from the International Association of Industrial Accident Boards and Commissions (IAIABC): Claims Electronic Data Interchange (EDI) Release 3.0. The standard uses Electronic Data Interchange, commonly known as EDI, so that data can be transmitted electronically between the WCB and its EDI Trading Partners quickly, efficiently, and cost-effectively.
EDI
See Electronic Data Interchange
Edit Matrix Table
The Edit Matrix Table details which data elements have edits applied to them and the error codes that are associated with those edits. It provides the language of the error codes that may be returned by the WCB in acknowledgments for electronic filings that have been rejected.
Election of Remedies
(WCB) - The right of a claimant (under Section 11 of the Workers' Compensation Law), whose employer was uninsured at the time of the accident, to bring a court action against such employer in lieu of claiming workers' compensation.
Electronic Data Interchange (EDI)
EDI is the structured transmission of data between organizations by electronic means. This exchange of data will take place between trading partners and the WCB.
Employer's Liability
Part of a workers' compensation insurance policy that protects an employer against legal liability for common law negligence damages, where an injury to an employee arises out of and in the course of employment but is not covered by the Workers' Compensation Law. In New York, this concept includes legal liability against employers by defendants in third-party cases (see Dole vs. Dow).
Employer Number
A unique employer identification number assigned by the Board. This number is generated by the Insurance Compliance (IC) system for each employer on record at the Board. It is stored in the Common Employer Database (CED), for use by both Workers' Compensation (WC) and Disability Benefits (DB). The Employer Number is the primary identifier for all employer records and documents, and is the preferred means of searching for employer records.
Employer Type
(WCB) - A one-character code used on the WCB's Compensated Cases Closed files to indicate a private sector employer or the type of public sector employer. Code values are: 0=Private employer; 1=State Insurance Fund; 2=Workers' Compensation Board; 3=Other NYS Department of Labor; 4=NYS Department of Transportation; 5=Other NYS government; 6=NYC government; 7=Other local government; 8=Civil defense volunteer; 9=Public employee and civil defense volunteer; X=Other public (e.g., Port Authority).
Employment Tenure
The length of time (years, months, etc.) that a worker has been employed by a particular employer.
ERNUM
Abbreviation for Employer Registration Number; same as UIER, abbreviation for Unemployment Insurance Employer Registration number
ES-202
(DOL, BLS) - A data program, administered by the U.S. Labor Department's Bureau of Labor Statistics, which provides a quarterly census of information on employers subject to ("covered under") Federal and State Unemployment Insurance (UI) laws. The employment security agencies in each of the fifty states, the District of Columbia, Puerto Rico, and the Virgin Islands provide the required data in several standardized outputs (deliverables) under the terms of their annual Federal/State Cooperation Agreement. Data collected for the ES-202 program includes a comprehensive list of all UI-covered establishments and federal employee installations from each state, along with name, address, monthly employment, quarterly wages, and other supporting administrative data. Establishment-level information is aggregated according to county location, ownership, standard industrial classification (SIC), et cetera. The State ES-202 Report is submitted to BLS-Washington five months after the end of each calendar quarter.
Establishment
(DOL) - A single physical location where services, operations, or other activities are performed. Where distinctly separate services, operations, or other activities are performed or conducted in separate areas at a single physical location, each activity may be treated as a separate establishment.
et al
Abbreviation for the Latin meaning "and others." Used to indicate that there are more members of a partnership than are shown
Event or Exposure Code
(OSH) - Numeric coding structure (4-digits, about 150 codes) used to describe the manner in which injury or illness was produced or inflicted by the Source of Injury. It is intended to replace the similar but less articulated ANSI Accident Type structure. {Examples: 4110=Overexertion in lifting object or objects; 0220=Struck by flying object}.
Examiner
(WCB) - Incumbent in either an Assistant Workers' Compensation Examiner job title or a Workers' Compensation Examiner job title who performs examining work, applying knowledge of law and of Workers' Compensation Board rules, regulations, policies, and procedures to compensation and disability benefit case information. Among the activities for workers' compensation cases that may be performed by Examiners determining whether a case should be indexed: evaluating claim forms and developing information required by judges for case decisions; requesting information (by phone, letter, etc.) needed for case development; evaluating whether a compensation case may be processed on an informal calendar; and preparing formal notices of decision based on judge's directions. The tasks of Workers' Compensation Examiners may include supervision of Assistant Workers' Compensation Examiners, examining more complex claims, answering correspondence, evaluating periodic reports from self-insured employers, and performing actuarial calculations (death cases, permanent total/partial disability, etc.).
Exclusive State Fund State
A state in which all workers' compensation insurance is underwritten by a state agency (also referred to as a "monopolistic" state fund state). Ohio and West Virginia are examples of states with this type of compensation system.
Exclusiveness of Remedy
Refers to the workers' compensation system's status as the exclusive remedy of an employee against her/his insured or lawfully self-insured employer. The system is the sole recourse that the employee, and/or her/his dependents or representatives have against such employers for injuries or death resulting from a work-connected accident or occupational disease.
Executive Officers
Executive Officers include: Executive Director, Deputy Exeutive Directors and General Counsel
Exhibit
Exhibits are documents (except for hospital records) submitted to the Board by a party at a hearing that do no have any other Form ID, are under 200 pages, and can be scanned as images into the ECF, where they are given the Form ID EXHIBIT.
Experience Rating
A method for determining an employer's workers' compensation premiums that reflects (a) a comparison of the employer's recent loss experience with the amount the employer would have been expected to pay if it had been an average employer in the same industry with the same payroll, and (b) the credibility or confidence assigned to the employer's loss experience. In practice, insurers assign no credibility to employers with average class premiums below a certain amount (e.g., $5,000/year).
Extent of Disability
A single-digit numeric code used by the WCB's R&S unit to characterize the disability classification assigned to a case closed with indemnity benefits. The codes are: 0=Death case; 1=Permanent total disability; 2= Permanent partial disability (PPD) - schedule award only; 3=Facial disfigurement award only; 4=Schedule PPD and facial disfigurement award; 5=Temporary disability only; 6=Temporary disability and facial disfigurement award; 7=Nonschedule PPD - lump sum settlement; 8=Nonschedule PPD - no present loss of earnings; 9=Nonschedule PPD - Carrier to continue payments.
Facial Disfigurement Awards, Cosmetic
Awards under Section 15(3) of the Workers' Compensation Law for serious facial or head disfigurement not involving a (compensable) loss of function. The awards are for proper and equitable compensation and are not to exceed $20,000.
Fatal Error
(eClaims) - An error that is received by a Claim Administrator when they fail to submit a mandatory field (DN) on a FROI or SROI transaction submitted to the WCB.
Federal Employer Identification Number (FEIN)
A nine-digit tax identification number assigned by the IRS for all employers other than sole proprietors. (A sole proprietor uses his social security number [SSN] as his business’s tax identification number.)
FEIN
Abbreviation for Federal Employer Identification Number, q.v.
File Number, Rating Board
(CIRB) - A unique six-digit number assigned by the CIRB to individual employers or to a group of employers who are combined for experience rating purposes.
Final Adjustment Award Hearing
(WCB) - A hearing held in Cases involving the loss or loss of use of a member or organ of the body in which the principal issue is the extent of loss or loss of use (e.g., claims normally involving schedule awards).
First Aid Treatment
(DOL) - One-time treatment and subsequent observation of minor cuts, scratches, burns, splinters and the like (even if treatment administered by a physician or by registered professional health care personnel), which do not ordinarily require medical care.
First Report of Injury (FROI)
A record of an event sent to the WCB that completes the first report of an injury requirement
Flat File
(eClaims) – A data processing format that contains claims data for specific claims from a Claim Administrator without any presentation format and that is transmitted electronically to the WCB. The transaction must be accepted by the WCB to be considered received by the WCB. Flat files are usually submitted by large companies that submit high volumes of claims.
FN
(Compliance) - Final Notice
FOIA/FOIL
See Freedom of Information Act/Law
Freedom of Information Act (Law)
The Freedom of Information Act (Abbrev. FOIA) is the Federal law concerned with ensuring public access to federal government records, with limited statutory exceptions. The New York State version (Public Officers Law, Article 6 - commonly referred to as the Freedom of Information Law or FOIL) requires all state and local government agencies to provide public access to all of their records, with limited exceptions. The Board has taken the position that claim information is not subject to FOIL as excepted based on personal privacy considerations.
FROI
See First Report of Injury
General Employer
(WCB) - A regular or parent employer who makes an employee available to a special employer. The general employer usually exercises indirect control and they, the special employer, or both may be liable for the compensation due to the injured employee.
HC
Abbreviation for Highway Contract Route Address
Hearing
(WCB) - The Workers' Compensation Law provides that no case may be closed without notice to all parties interested, with all such parties having an opportunity to be heard. The Workers' Compensation formal "hearings" are held before Workers' Compensation Law Judges who hear and determine claims for compensation, for the purpose of ascertaining the rights of the parties.
Hearing Point
(WCB) - facilities, other than the nine district offices, for which calendars are prepared and at which hearings are held.
IAIABC
See International Association of Industrial Accident Boards and Commissions
IC, IC2
(Compliance) Insurance Compliance, the Insurance Compliance system. The Board's system for tracking employers’ compliance or noncompliance with the requirement to maintain insurance coverage under NYS Workers’ Compensation and Disability Benefits law.
IEU
Insurance Examining Unit of the Disability Benefits Bureau; its function is similar to that of the Employer Coverage Unit of Workers' Compensation.
Illegally Employed Minor
(WCB) - Decision element possible in a workers' compensation case involving an injured worker who, at the time of the accident, was under the age of 18 years and was permitted or suffered to work in violation of the New York Labor Law. Cases in this category can give rise to double compensation.
Image
(Scanning prep) - Electronic representation of part or all of a document. A document may have one or several images. One side of a piece of paper equals one image. In the example of a four-page letter, each page is one image; therefore, the letter (a single document) is made up of eight images (pages).
IN
(Compliance) - Abbreviation for investigation package
In Line of Duty
(WCB) - Injuries to volunteer firefighters or volunteer ambulance workers are deemed to be "in line of duty" if incurred at a fire/ambulance service site or in necessary travel to and from such a site. Injuries or illnesses also are "in line of duty" if they result from hazards and exposures associated with the volunteer's service (e.g., while at a firehouse, hospital, etc.). In "line of duty" is used for volunteer firefighters and ambulance workers in the same sense as "arising out of and in the course of employment" is for employees.
Incidence Rate
Frequency of occurrence per unit of potential occurrence
Incidence Rate
(DOL) - The number of occupational injuries and/or illnesses, or lost workdays, experienced by 100 full-time workers during a given year. This may be expressed as: Incidence Rate=(N x 200,000)/EH, where N=number of injuries and/or illnesses, or of lost workdays; EH=total hours worked by all employees during the reference year; and 200,000=base annual hours for 100 full-time equivalent workers (working 40 hours per week, 50 weeks per year).
Incomplete Case
A case which does not have a First Report of Injury or C-3 plus a C-4 or equivalents present.
Incurred Losses
(NCCI, CIRB, Carriers) - Indemnity and medical losses that are recognized by a carrier at a particular valuation date, including (a) payments already made, (b) reserves for future payments, (c) estimated present value of future payments, if applicable and (d) deductions for benefit offsets, subrogation or other deductions from losses, if applicable.
Indemnity Benefits
Compensation paid to the workers' compensation claimant (or relatives) for non-medical loss resulting from an injury or illness. Six types of award are permitted by the Workers' Compensation Law: temporary total disability benefits (for periods of total wage loss during the recovery period following an accident or exposure); temporary partial disability benefits (for periods of partial wage loss during the injury's recovery period); facial disfigurement awards (at judge's discretion but subject to a maximum, for cosmetic facial disfigurement resulting from the accident or exposure); permanent partial disability benefits (for loss of physical function or for periods of partial wage loss after a claimant has been classified as having a permanent partial disability); permanent total disability benefits (for loss of wage earning capacity after a claimant has been classified as having a permanent total disability); death benefits (compensation benefits awarded to spouse, children or other family members following the work-related death of a worker).
Indexed Claim (auto-assembled via claims EDI)
(WCB) - A complete case without any of the following present: Acceptance, Denial, or Report of Payment.
Indexed Claim (manually assembled)
A complete case without any of the following present: Acceptance, Denial, or Report of Payment. NOTE: If a C-3 is present and has the prior injury and treatment boxes checked, there must also be a signed C-3.3 present to index.
Industry Code
(SIC) - See Standard Industrial Classification
Injury Type
(CIRB) A numeric coding structure (1 digit, 5 codes) used to identify the carrier's estimate (as of a particular valuation date) of the disability classification of the claim, using one of the following codes: 1=Death, 2=Permanent Total Disability, 5=Temporary Total or Temporary Partial Disability, 6=Medical Only Claims, or 9=Permanent Partial Disability. Compare with the WCB's Extent of Disability coding structure.
Insurance Compliance System (IC2)
Computer system used by the Compliance Bureau and the Disability Benefits Bureau to record employers’ workers’ compensation and disability benefits coverage. The system assigns unique Employer Numbers for each employer on record. It also assesses employer penalties for non-compliance with the requirement to carry coverage, and issues penalty notices to employers.
Insurance Group
Insurance carriers with common ownership
International Association of Industrial Accident Boards and Commissions (IAIABC)
An organization of administrative law agencies responsible for the workers' compensation systems in states, provinces and other jurisdictions. This body created the national standards for electronically reporting policy and coverage information to workers’ compensation agencies. The Board has adopted these standards for insurers’ electronic proof-of-coverage submissions. The transactions insurers submit are posted to the Board's Insurance Compliance (IC2) system. Most are posted automatically by a batch program run at night.
JCN
See Jurisdiction Claim Number
JD
(Compliance) - Abbreviation for Judgment Package
Job Tenure
The length of time (years, months, etc.) that a worker has held a particular job with a particular employer.
Judge
See Workers' Compensation Law Judge
Judgment
(Compliance) - Court order obligating a debtor to pay. The Workers' Compensation Board obtains judgments against employers that fail to pay penalties.
Jurisdiction
(WCB) - The right to hear and determine a workers' compensation case. The Workers' Compensation Board has jurisdiction over cases with employment in New York State (hired in, work in, control out-of-state employees from, claimant resident in, claimant domicile in, or injury occurrence in New York State) for persons in employment covered under the Workers' Compensation Law, Volunteer Ambulance Workers Benefit Law or Volunteer Firefighters Benefit Law. Notable exclusions from the WCB's jurisdiction in New York State include federal government employees, certain employees of local governments, many NYC government occupations (civil service police, firefighters, sanitation workers), most NYC teachers, workers covered by separate compensation systems (maritime employments, merchant seafarers, interstate railroad employees, etc.), casual employments (yard work by minors, babysitters, etc.), et cetera. Coverage for some worker classes in New York is elective (e.g., part-time household workers, sole proprietors, corporate officers, certain musicians, farm workers earning less than $1,200 per year, etc.).
Jurisdiction Claim Number (JCN)
The JCN is the WCB case number.
JV
Abbreviation for Joint Venture, two or more employers participating in a partnership
Lapse Checker
(Compliance) - Program that reads all employer coverage records on the Insurance Compliance system to determine coverage status. The Lapse Checker updates the Process Control function.
Lead Case
The rule of thumb is that the oldest indexed case is the lead case. If there is an associated case that is one of the following, it supercedes the rule of thumb and becomes the lead case:
  1. Open No Insurance case
  2. Open Death case
  3. Open case in which Special Funds (25a) is the carrier
Legacy Claim
Any claim in existence at the time a trading partner begins EDI.
Licensed Representative
(WCB) - (a) Any person other than an attorney who is authorized by the Workers' Compensation Board to represent claimants before the Board and, in some instances, to receive a fee, fixed by the Board, for such services; also (b) Any person other than an attorney who is authorized by the Workers' Compensation Board to represent self-insureds before the Board.
LLC
Abbreviation for Limited Liability Company
LLP
Abbreviation for Limited Liability Partnership
Loss Profile
A generic term referring to summaries of workers' compensation experience that may include information about losses (e.g., medical, indemnity and/or other costs), accident frequency, injury severity and/or other quantitative measures. Loss profiles for a specific employer or industry are frequently employed in highlighting current workplace hazards and developing employer safety programs.
Loss Ratio
A ratio of losses (total, indemnity, medical, etc.) to premium (manual, standard earned, net earned, etc.), indicating losses as a proportion of premium.
Lost Time
(WCB) - A period of total wage loss and loss of earning capacity, beyond the waiting period (first 7 days of disability for workers' compensation cases), caused by the claimant's work-connected disability. In workers' compensation cases only, if the disability period exceeds 14 days, compensation will be paid from the first day of disability; there is no waiting period for volunteer ambulance worker or volunteer firefighter cases.
Lost Workday Cases
(DOL) - Cases in which, on the day or days following the day of injury or illness, the employee is either absent or is present but unable to perform all duties regularly assigned.
Lost Workdays
(DOL) - The number of consecutive or non-consecutive days on which a worker, because of injury or illness: (a) would have worked, but could not; (b) was assigned to another job on a temporary basis; (c) worked at a permanent job less than full time; or (d) worked at a permanently assigned job but could not perform all duties normally connected with it. The number of lost workdays does not include the day of injury or onset of illness, or any days on which the person would not have worked even if able to work.
LP
Abbreviation for Limited Partnership. An LLP has one or more general partners and multiple limited partners. The general partners manage the business and are responsible for debts. The limited partners invest but have no voice in management and are not responsible for the partnership's debts.
Lump-Sum Settlement
(WCB) - A negotiated and WCB-approved agreement, termed a "nonschedule adjustment," between a claimant with a nonschedule permanent partial disability and the claim defendant(s). As a result of the agreement the claimant receives a sum of money representing all future compensation for her/his disability, and the case is considered closed. Under Section 15(5-b) of the Workers' Compensation Law, granting of a settlement by the Board requires that (a) the right to compensation has been established and compensation has been paid for at least three months; (b) the continuance of disability and of future earning capacity cannot be ascertained with reasonable certainty; (c) there has been a physical examination of the claimant prior to approval; and (d) the Board considers the settlement "fair and in the best interest of the claimant." In practice, lump-sum settlements usually are final, but the Section provides for reopenings if the Board finds that there has been a change in condition or degree of disability not contemplated at the time of the settlement.
Maintenance Type Code (MTC)
The MTC defines the specific purpose of each FROI/SROI transaction being submitted.
Managed Care
A system of health care delivery that tries to manage the cost of health care, the quality of that care and access to that care. Typical characteristics of managed care include a defined network of providers, a fixed reimbursement system, and a utilization review process (emphasizing both quality assurance and avoidance of unnecessary services). A managed care pilot program for workers' compensation cases (including only voluntarily participating employers who meet qualification criteria) was enacted by the State Legislature in December, 1993.
Manual Rates
(NCCI, CIRB) - The listed premium, stated as dollars per $100 of weekly earnings for each employee, in a state's current schedule. In New York and in more than 40 NCCI and NCCI-affiliated states, the manual rates are linked to the Classification Code system (i.e., rates are stated for each work classification code used in the state).
Maximum Medical Improvement
(WCB) - An assessed condition of a claimant based on medical judgment that (a) the claimant has recovered from the work-related injury to the greatest extent that is expected, and (b) no further change in her/his condition is expected. A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant.
Medical Benefits
Medical treatment provided, under the Workers' Compensation Law, to injured workers as a result of injuries arising out of and in the course of employment.
Medical Fee Schedule
(WCB) - A schedule, established by the Chair of the Workers' Compensation Board, of charges and fees for medical treatment and care furnished to workers' compensation claimants.
Medical Treatment
(DOL) - Care (other than first aid) administered by a physician or by registered professional personnel under the standing orders of a physician.
Modify (a Decision) - (WCB) A decision that partially changes a previous decision; e.g., a Board Panel memorandum of decision that amends a Workers' Compensation Law Judge's decision.
Monopolistic State Fund State
See Exclusive State Fund State
MSC
Abbreviation for Mail Stop Code; this can be part of an address
MTC
See Maintenance Type Code
MTC Filing Instructions
The MTC Filing Instructions detail the MTC that must be filed to report a specific claim event and the filing due dates for the Claim Event.
Multi-Page, Separate Document
(Scanning prep) - A separate document (see definition below) that comprises more than one sheet of paper; for example, a single form comprising more than one page or correspondence comprising several pages. Each document is distinct and does not qualify as a multi-type document because it never has any attachments or other forms scanned as part of the document.
Multi-Type Document - (Scanning prep)
Document that contains a form and/or correspondence that are combined into one document for scanning purposes, based on the rules for document preparation. Multi-type documents always contain multiple pages and may contain several WCB Form types. After scanning the resulting electronic document will have a single document ID and a single set of identifiers. A vendor-supplied DTS sheet is used between two multi-type documents to indicate where one multi-type document ends and the next begins.
NAIC
See National Association of Insurance Commissioners
National Association of Insurance Commissioners
A private association of insurance regulators in the United States; it promulgates rules and model statutes for possible adoption by member states.
National Council on Compensation Insurance (NCCI)
An association of workers' compensation insurers that serves as the workers' compensation rating organization in about two thirds of the states. The NCCI attempts to establish standards for use in ratemaking, develops policy forms, collects statistics, and provides statistical support and services.
National Institute for Occupational Safety and Health (NIOSH)
An agency within the U.S. Department of Health and Human Services established in 1970. NIOSH is part of the Centers for Disease Control and Prevention and generally is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. NIOSH's responsibilities include: investigating potentially hazardous working conditions (as requested by employers or employees), evaluating workplace hazards, creating and disseminating methods for preventing disease/injury/disability, conducting scientifically valid research on safety issues, and providing education and training in the field of occupational safety and health.
Nature of Injury/Illness
(ANSI/OSH) - Numeric coding structure (3-digit ANSI, 4-digit OSH; 150+ codes in each) used to identify an injury in terms of its principal physical characteristics. {Examples: Sprain or strain = 310 (ANSI), 0130 (OSH); Fracture = 210 (ANSI), 0111 (OSH-Closed fracture), 0112 (OSH-Open fracture), 0119 (OSH-Multiple fracture)}.
Nature of Injury/Illness
(CIRB) - A numeric coding structure (2 digits, 43 codes) used as part of the New York Workers' Compensation Statistical Plan to identify the nature of injury. {Examples: 28=Fracture; 64=Silicosis}.
Nature of Injury/Illness
(WCIO) - A numeric coding structure (2 digits, 54 codes) used as part of eClaims, and required by IAIABC for EDI transactions, to identify the nature of injury on FROI transactions. {Examples: 10=Contusion; 28=Fracture}.
NCCI
See National Council on Compensation Insurance
NE
(Compliance) Abbreviation for No Employees
Net Earned Premium
See Premium
New Mail
(Scanning prep) - Newly received, unprocessed papers that arrive at the NYS Workers’ Compensation Board by means of the US Postal Service, by courier, by fax, or by other means.
New York Committee for Occupational Safety and Health
(NYCOSH) - An organization of individuals and local labor unions concerned with workplace safety. NYCOSH provides members with a quarterly newsletter, a clipping service, a resource library, updates regarding pending worker health and safety legislation, conferences, forums and committee participation. Local union services include health and safety training, technical assistance, consultations and on-site evaluations, and contract language assistance.
New York Compensation Insurance Rating Board
(CIRB or NYCIRB) - A private, non-profit association of licensed insurance companies that provide workers' compensation insurance in New York. The organization is responsible for, among other things, collecting and reviewing compensation loss experience from carriers, developing policy forms and rating plans, conducting actuarial analyses, and preparing rate filings with the (New York State) Insurance Department.
New York State Assessments
A separate identifiable policy charge, paid by employers, established by the New York Legislature as of 4/1/94 to provide primarily for the funding of Special Funds and WCB expenses. Previously, these assessments were included in developing the workers' compensation manual rates.
NFP
(Compliance) - Abbreviation for Not-for-Profit
NIOSH
See National Institute for Occupational Safety and Health
No-Claim File
(WCB) - Files consisting of forms, papers, or correspondence received by the Board which do not warrant assembling into claim case folders.
No Further Action (NFA)
(WCB) - To remove a case from further consideration on the calendar unless action is taken by Parties of Interest (POI). The decision to change the status of a case to No Further Action (NFA) is based upon the determination that no further rulings by the Board can be made unless action is taken by Parties of Interest (POI). This case status is indicated by a statement on a WCB decision (e.g., "No further action is planned by the Board at this time").
Non-Compensated Case
(WCB) - A closed case which was never awarded indemnity benefits
Non-compliance
Failure of an employer to obtain Workers' Compensation or Disability Benefits insurance coverage when required to do so by law
Non-Scannable Object (NSO)
Non-scannable objects (NSOs), that can be submitted to the Board by a party at a hearing or prior to the hearing, are documents over 200 pages, hospital records, booklets or bound documents, maps, x-rays, videotapes, cds, diskettes, or any other material objects that can not or will not be scanned as an image into ECF. Instead, the NSOs will be kept in a designated location in the District office and a description sheet, identifying the object and its location, will be scanned into the electronic case file with the Form ID of NS-Object.
Nonschedule Permanent Partial Disability
Non-fatal injuries that do not involve schedule permanent partial disabilities or cosmetic facial disfigurement are assigned permanent disability benefits based on the claimant's actual or presumed wage loss, with benefits to continue for the duration of the wage loss disability.
Notice
(WCB) - Written notification from an employee to her/his employer, indicating that a work-connected injury or illness has occurred. For injuries, notice must be given no later than 30 days after the accident. The Board may excuse a failure to give notice on the grounds that (a) for some reason, notice could not have been given; (b) the employer had knowledge of the accident; or (c) the employer's case has not been prejudiced. In cases involving occupational diseases, the time period for notice is two years from the date of disablement or from the date when the employee knew, or should have known, that the disease was due to the nature of employment.
NS
(Compliance) - Abbreviation for Not Subject (to the requirement to maintain Workers' Compensation or Disability Benefits insurance coverage)
NYCIRB
See New York Compensation Insurance Rating Board
NYCOSH
See New York Committee for Occupational Safety and Health
OB
(Compliance) - Abbreviation for Out of Business
Occupation
(Census Bureau) - A numeric coding structure (3 digit, 400+ codes), widely adopted by federal, state, and private occupation analysts, for identifying the occupation of an injured worker. {Examples: 433=Supervisors, Food Preparation and Service Occupations; 434=Bartenders; 435=Waiters and Waitresses; 436=Cooks; 438=Food Counter, Fountain and Related Occupations; 439=Kitchen Workers, Food Preparation}.
Occupational Disease (OD)
A disease arising from employment conditions for a class of workers, with the disease occurring as a natural incident for particular occupations, distinct from and exceeding the ordinary hazards and risks of employment. To be considered an occupational disease, there must be some recognizable link between the disease and some distinctive feature of the worker's job.
Occupational Disease
(WCB) - Disabling non-accidental injuries and illnesses arising from conditions of employment, including occupational hearing loss and 30 diseases listed under Section 3(2) of the Workers' Compensation Law. A distinguishing characteristic of occupational diseases is the lack of a clear date of accident -- so special rules are needed in OD cases to establish a date of disablement, "timely notice" requirements, etc.
Occupational Disease, Notice and Causal Relationship (ODNCR)
(WCB) Minimal conditions that must be met before financial responsibility can be assigned to a claim for workers' compensation based on occupational disease. Specifically, it must be established that (a) the claimant has an occupational disease recognized by the Workers' Compensation Law; (b) the claimant has, after the onset of the disease, notified her/his employer within the time limit set by the Workers' Compensation Law for occupational diseases (two years from date of disablement or from date when claimant knew or should have known that the disease was due to the nature of the employment, whichever is greater); and (c) a causal relationship exists between work-related activities and exposure, the development of the occupational disease, and a subsequent disability.
Occupational Illness
(DOL) - Any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment, including acute and chronic illnesses or diseases which may be caused by inhalation, absorption, ingestion or direct contact.
Occupational Injury
(DOL) - Any injury, such as a fracture, sprain, amputation, etc., which results from a work accident or other exposure involving a single accident in the work environment.
Occupational Safety and Health Administration (OSHA)
A unit of the U.S. Department of Labor that develops and promulgates occupational safety and health standards; develops and issues regulations; conducts investigations and inspections to determine the status of compliance with safety and health standards and regulations; issues citations and proposes penalties for non-compliance with safety and health standards and regulations; assists and encourages states to develop occupational safety and health plans that are "as effective in the field of occupational safety and health."
Occupational Safety and Health Program (OSH)
A coding structure designed through the Federal Bureau of Labor Statistics to replace the ANSI coding structures that have been used in Federal reporting since 1978. The OSH system includes coding structures for Nature of Injury/Illness, Part of Body Affected, Source of Injury/Illness, Event or Exposure and Secondary Source of Injury/Illness.
OD
See Occupational Disease
ODNCR
See Occupational Disease, Notice and Causal Relationship
Onset Date
(WCB) - The starting date of disablement for an occupational disease, as established by the Workers' Compensation Board.
OSH
See Occupational Safety and Health Program
OSHA
See Occupational Safety and Health Administration
Partial Denial
(eClaims) - A SROI MTC used when a Claim Administrator is denying indemnity in part or whole on a claim. A SROI-PD transaction cannot be used to deny medical on the claim.
Part of Body Injured
(ANSI/OSH) - Numeric coding structure (3-digit ANSI, 4-digit OSH) used to identify the part of an injured person's body directly affected by an accident or occupational disease. Approximately 70 code values are used in these structures. {Examples: Back, external=420 (ANSI), 2210 (OSH); Knee=513 (ANSI), 4120 (OSH)}.
Part of Body Injured
(CIRB) - A numeric coding structure (2 digit, 44 codes) used as part of the New York Workers' Compensation Statistical Plan to identify the part of body injured. {Examples: 24=Neck-Larynx; 53=Knee}.
Part of Body Injured
(WCIO) - A numeric coding structure (2 digits, 56 codes) used as part of eClaims, and required by IAIABC for EDI transactions, to identify the nature of injury on FROI transactions. {Examples: 32=Elbow; 42=Lower Back Area}.
Party of Interest
Any person or organization (e.g., the carrier, claimant representative, hospital, etc.) that is placed on notice for hearings and/or decisions.
PC1
(Compliance, IC2) - That part of a transaction that identifies the legal entity that is the policyholder. This is the proof-of-coverage record for the insured named in the transaction. The policy number and policy effective date, as well as the nature and purpose of the transaction are also identified.
PC2
(Compliance, IC2) - That part of a coverage manual posting (CMP) transaction that identifies all entities and locations (generally referred to as “additional insures) covered by the policy. This is the proof-of-coverage record for the employer(s) named in the transaction. These may be multiple legal entities or multiple trade names; they are not required to be separate legal entities. Insurers must submit an FEIN or UIER for each additional insured.
Penalties
(WCB) - Assessments against carriers, employers and claimant attorneys/reps for specific violations covered in Section 25 of the Workers' Compensation Law or Section 330.2 of Title 12 of the New York Code Rules and Regulations (NYCRR). Violations covered by penalties include: Failure to pay compensation installment within 25 days after same becomes due; Failure to file a Denial or promptly begin compensation payments; Failure to pay compensation according to terms of an award within 10 days of the award (except in case of appeals); Failure (of an employer or a carrier) to promptly file a notice or report requested by the Board or Chair;

Finding (by the Board) that an employer or a carrier has objected without cause; Failure of a carrier to promptly file a Report of Payment; Finding that a carrier has engaged in dilatory tactics or exhibits unjustified lack of preparedness; Finding of frivolous adjournment in special "stale case" part (against a carrier or a claimant's attorney/rep); Failure of a carrier to make payments required by a conciliation agreement; Failure of an employer or a carrier to file a medical report (NYCRR; all other penalties listed are based on the WCL). Money penalties are payable to the Chair of the Workers' Compensation Board, the Board or the claimant, as specified by law; failure to file a Denial also bars the claim defendant from contesting ANCR or ACOE issues. Penalties for failure to file a Report of Payment are mandatory, but for other violations, either the finding of violation or the imposition of penalty is at the discretion of either a Judge or the Board.
PESH
See Public Employees Safety and Health Bureau
PFME
See Prima Facie Medical Evidence
Physical Rehabilitation
A medical treatment or therapy program (e.g., exercise programs, training in the care and use of a prosthetic device) designed to help an individual cope with or overcome the physical effects (e.g., motor deterioration) of a physical disability.
PLLC
Abbreviation for Professional Limited Liability Company
POC
(Compliance, IC2) - Proof of Coverage, q.v.
Policy Data
Data collected with the intent of supporting reviews of existing policies (laws, rules, guidelines, etc.) and the development of new policies.
Policy Number
A number assigned by a compensation insurance carrier to a workers' compensation insurance contract with a particular employer.
Premium
The total amount paid for an insurance policy. For workers' compensation insurance, premiums are normally calculated using a rate per $100 of the payroll for covered employees. The following are some of the premium concepts involved in moving from published (or "book") rates to actual employer costs: manual premium (based on the manual rates schedule and the employer's payroll); standard earned premium, excluding constants (based on the manual premium adjusted by the employer's experience rating factor); standard earned premium, including constants, reflecting the effect on the standard earned premium of adding expense constants (flat charges to cover minimum costs of issuing and servicing policies) and loss constants (in some states, constants added to offset the generally poorer safety record of smaller businesses); net earned premium, reflecting adjustments to the standard earned premium, including premium discounts (e.g., discounts given to employers with larger payrolls, reflecting economies of scale in servicing larger policies), deductible premium credits and the effect of retrospective ratings; and the net cost to the policyholder, reflecting possible adjustments to the net earned premium due to policyholder dividends and the New York State Assessment.
Present Value
The amount of money presently needed to ensure payment of a future financial obligation, assuming a specified schedule of payments and a specified interest rate earned by the funding account. Present value calculations are widely used in workers' compensation cases to estimate the cost of continuing permanent partial or permanent total disability indemnity benefits--often using claimant- or benefit-mortality tables to estimate the expected duration of payments. {Example: The present value of $100 payable in 1 year, assuming a 6% annual interest rate, is $100 x 1.00/1.06 or $94.34. The present value of $200 in payments, with $100 payable after 1 year and $100 payable after 2 years, assuming a 6% interest rate compounded annually, is ($100 x 1.00/1.06) + ($100 x 1.00/1.06 x 1.00/1.06) = $94.34 + $89.00 = $183.34.}
Prima Facie Medical Evidence (PFME)
A finding by the WCLJ that the medical report in the file is sufficient to proceed further in the hearing process. A finding that the Medical Report or Reports constitute prima facie medical evidence is an evidentiary determination that the case may proceed and is interlocutory and is not reviewable by the Board.
Proof of Coverage (POC)
Electronic transactions insurers submit to the Board to report all policy and coverage activities for employers they insure. Activities include issuing, canceling, reinstating, and renewing workers' compensation policies or coverage under a specific policy.
Pro-Se Claimant
A pro-se claimant is an individual who is not represented by an attorney or licensed representative.
Protracted Healing Period
(WCB) - In cases involving a schedule permanent partial disability, if the WCB finds that the healing period (period of temporary total disability) exceeds the normal healing period allowed for the injury by the Workers' Compensation Law (Section 15(4-a)) than awards for the protracted healing period may be added to the award. {Example: A claimant suffers a 25% permanent loss of use of an arm (.25 x 312 week maximum = 78 weeks schedule award) and the claimant is judged to have been unable to work for 40 weeks, rather than the 32 week normal healing period; the award is for 78 (schedule) + 8 (protracted healing) = 86 weeks}
Pseudo Box
To minimize the use of cardboard boxes for just a few pieces of mail, mail is prepped and placed in an expandable folder which is then processed as if it were a box of new mail. The folder is labeled with ALL of the usual box bar-coded labels and is treated just like a box by the scanning vendor. Pseudo boxes (folders) are then placed in a cardboard box for security during transport. The cardboard box is identified by the statement: “This box contains {n} individual pseudo boxes of incoming mail.” Where “n” = the number of pseudo boxes inside of the cardboard box.
Public Employees Safety and Health Bureau (PESH)
Unit of the New York State Department of Labor which enforces a New York State law passed in 1980 giving State and local government employees the same job safety protection as that afforded to private workers under the Federal Occupational Safety and Health Administration (OSHA). The New York State PESH program is an approved state plan under OSHA, receiving about 50% of its funding from the Federal government.
Quarterly Unemployment Insurance Address File
(BLS, DOL) - A component of the Bureau of Labor Statistics ES-202 Program that provides a comprehensive list (name, address, monthly employment, quarterly wages, etc.) of all UI-covered establishments and Federal installations in each State. The QUI is submitted to BLS-Washington five months after the end of each calendar quarter.
QUI
See Quarterly Unemployment Insurance Address File
Quick Code Reference List
This is a reference list of the IAIABC codes that the WCB will be accepting. The list provides a quick summary of MTC codes, Benefit Type Codes, Full Denial Reason Codes, and other commonly used codes in FROI and SROI transactions. A copy of the reference list is available in the Zone Quick Code Reference List.
R Forms
A form that the Carrier is required to file with the Chair after the earliest of (a) the date on which the Claimant's total lost time exceeds eight weeks; (b) the date on which rehabilitation services were instituted or arranged; or (c) the date on which rehabilitation services were deemed necessary, even if not instituted or arranged. The form includes information about the case, date of disablement, lost time, injury diagnosis, Claimant's occupation, attending Physician and information about current medical/vocational rehabilitation services if any. The R forms are reviewed by the WCB's Rehab Bureau to determine whether follow-ups (e.g., with the Claimant) are appropriate.
Receiver
A person appointed by the court to hold in trust and administer property under litigation, to wind up the affairs of a business, or to manage a corporation during its reorganization.
Recruitment Request Form
HRM Recruitment Request Form
Redesign of the Occupation Safety and Health Program (ROSH)
Former name for the Occupational Safety and Health Program.
Redetermination
(Compliance) - An administrative appeal process used by entities that have had penalties assessed for non-compliance with Workers' Compensation Law.
Reduced Earnings
(WCB) A compensation rate based on the claimant's partial wage loss or partial loss of earning capacity due to a condition related to a compensable work-connected injury.
REEMP
Carrier to reimburse employer for wages paid
Registration Section
The organization within the NYS Department of Labor responsible for establishing the correct legal entity for each Unemployment Insurance Registration (UIER) number or Federal Employer Identification Number (FEIN).
Rehabilitation Services
Services aimed at restoring an individual to an adequate or to an optimal state of health, constructive activity or employment (see also Physical Rehabilitation, Vocational Rehabilitation).
Reimbursement, Request for
(WCB) - (a) A request by an employer for reimbursement for wages paid to an employee for a period during which the employee was eligible to receive workers' compensation or disability benefits. (b) A request by a compensation carrier for reimbursement out of the Special Disability Fund (Second Injury Fund). (c) A request by a disability benefits carrier for reimbursement of benefits paid to a claimant while the workers' compensation case was being litigated.
Reinstatement
(Compliance) - To reactivate a cancelled insurance policy; to make a cancelled policy effective again.
Rejected Transaction
(eClaims) - A FROI or SROI transaction must meet all Data Element Requirements and Edit Matrix Table requirements or the specific transaction will be rejected electronically by the WCB. Only transactions that are accepted by the WCB are considered received by the WCB for claims purposes (ie. a rejected transaction that is not resubmitted successfully to the Board could result in a penalty, if applicable).
Reopened Case
(WCB) - A workers' compensation case which has been closed by a Workers' Compensation Law Judge or a Board Panel that is subsequently made active again to determine the claimant's eligibility for benefits.
Reopened Cases Fund
(WCB) - A fund established to assume liability for additional awards in cases where the application to reopen the case occurs more than 7 years from the date of injury and more than 3 years from the payment of the last payment of compensation. The fund is financed through payments in non-dependency death cases and through assessments made periodically against all carriers.
Report of Payment
A term utilized by the WCB to describe any C-8/8.6 and/or SROI transaction that reports a payment on a claim.
Rescind (a Decision)
(WCB) - A Board Panel memorandum of decision which voids or annuls a Workers' Compensation Law Judge decision. (Decisions to rescind are usually issued without prejudice in order to allow the parties to present evidence or testimony not previously presented to a Workers' Compensation Law Judge.)
Retrospective Rating
A method for determining an employer's insurance premium based on: (a) minimum and maximum premium limits; (b) losses the employer incurs during the policy period; (c) expenses related to losses; and (d) a charge for fixed expenses. In its pure form, retrospective rating resembles "self-insurance" administered through an insurance carrier; use of this method is optional, and it is used as agreed to by the employer and the insurance company.
Review, Request for
(WCB) - A written request for a Board Panel review of a Workers' Compensation Law Judge decision.
RLLP
Abbreviation for Registered Limited Liability Partnership; a partnership in which each partner is a professional licensed by the State of New York. The partnership itself is registered with the NYS Department of State.
ROSH
See Redesign of the Occupational Safety and Health Program
RP
(Compliance) - Abbreviation for Rescinded Penalty
Sample
A subset of a population (collection of potential observations) that is drawn and observed with the intent of making inferences about the likely characteristics of the population. Justifiable population inferences generally require a sample that may be viewed as "representative" of the population, and to achieve that end, numerous sampling strategies may be adopted, including: random sampling (each element of the population has an equal chance of being selected); stratified sampling (subgroups or strata are identified, sampling is done within strata, and the results are weighted to reflect the proportion of population cases in each strata); cluster sampling ("natural" subgroups or clusters--such as employers--are identified, clusters are selected, and sampling is done within clusters, and observations are weighted to reflect the relative size and frequency of similar clusters in the population).
Scheduled Loss of Use (SLU)
Maximum benefit week schedules in the Workers' Compensation Law generally are used in determining lifetime benefits for permanent partial injuries to an arm (312 weeks), leg (288 weeks), hand (244 weeks), foot (205 weeks), eye (160), finger (25-75 weeks, depending on digit), toe (16-30 weeks), or for hearing loss (60 weeks for one ear, 150 weeks for both). Injuries amounting to less than a 100% functional loss are awarded a percentage of the scheduled weeks, and there are also special provisions for additional weeks required for a protracted healing period.
Second Injury Fund
A special fund, technically known in New York as the Special Disability Fund, which assumes, in certain cases, part of the permanent disability liability resulting from injuries to previously handicapped workers. The fund, which is funded by assessments against carriers and self-insureds, was created to assure handicapped workers receive full workers' compensation benefits, while encouraging employers to hire physically handicapped persons by protecting them against disproportionate liability in the event of subsequent employment injury.
Secondary Source of Injury/Illness
(OSH) - Numeric coding structure (4 digit, 400+ codes) used to identify the machine, equipment, object, or substance that generated the (OSH) Source of Injury or Illness, or was related to the (OSH) Event or Exposure. The code values for this structure are identical to the values used for Source of Injury or Illness. Secondary Source is intended to replace the current ANSI Associated Object or Substance coding structure.
Self-Insurance
(WCB) - A method by which an employer or group of employers may secure the payment of workers' compensation benefits to employees by depositing securities or a surety bond in an amount required by the Workers' Compensation Board (this requirement is waived for local government self-insures); the self-insurance method is in lieu of purchasing insurance from an insurance carrier.
Separate Document
(Scanning prep) - A document that does not qualify as a multi-type document in that it is never combined with another form or attachments. A separate document may consist of one sheet of paper (single-page, separate document) or several sheets of paper (multi-page, separate document).
Sequela (pl. Sequelae)
A disease or other medical condition following from, and usually related to, a previous disease or condition; in workers' compensation cases, the possibility of sequela can result in accidental injuries that are different from resulting work disabilities. {Example: an accident results in an injured knee, and efforts to hobble back to work with the injury result in a back strain}
Shift Start Time
The time of day at which a worker’s shift begins.
SIC
see Standard Industrial Classification.
SIF
see State Insurance Fund.
SL
(Compliance) - Abbreviation for Statutory Lapse or Stat Lapse, a definite (closed) period during which an employer had no Workers' Compensation or Disability Benefits insurance, and was therefore out of compliance with Workers' Compensation Law
Social Security Number (SSN)
A nine-digit tax identification number assigned by the IRS for all individuals. Sole proprietors of a business use the social security number as their businesses' tax identification number, while all other employers use an FEIN, q.v.
Source of Injury/Illness
(ANSI/OSH) - Numeric coding structure (4-digits) used to identify the object, substance, exposure or bodily motion which directly produced/inflicted the injury or illness. The ANSI scheme involves about 300 codes, and the OSH system adds a significant number of new codes. {Examples: 6020 = Person, other than injured (ANSI); 5351 = Employee, other than injured (OSH); 5352 = Resident of health care institution (OSH); 5359 = Person, other than injured, Not Elsewhere Classified (OSH)}
Special Disability Fund
see Second Injury Fund
Special Funds
(WCB) - Funds established under the Workers' Compensation Law to assure payment of benefits associated with claims, usually be transferring all or part of the liability to the Fund. {Examples: Reopened Cases Fund, Second Injury Fund}
Special Funds Conservation Committee
(WCB) - A committee established to defend claims made against the Special Funds.
SROI
See Subsequent Report of Injury
SSN
Social Security Number, q.v.
Standard Earned Premium
see Premium.
Standard Industrial Classification (SIC)
A Federal numeric coding structure (4-digits, 1000+ codes) used to identify the principal business conducted by establishments (e.g., 2-digit major industry group codes that contain 3-digit industry group codes, that in turn contain 4-digit industry codes); the SIC structure is sponsored by the Office of Management and Budget (Executive Office of the President) and is utilized by all Federal agencies (including OSHA, BLS) and many States. {Example: 57 = Home Furniture, Furnishings and Equipment Stores; 573 = Radio, Television, Consumer Electronics and Music Stores; 5731 = Radio, TV and Electronics Stores; 5734 = Computer and Software Stores; 5735 = Record and Prerecorded Tape Stores; 5736 = Musical Instrument Stores}
State Insurance Fund (SIF)
New York State agency whose activities include (a) providing workers' compensation insurance coverage to private and public employers, (b) providing other lines of insurance coverage (disability benefits, etc.) and (c) acting as an agent for New York State in workers' compensation cases involving NYS employees. The State Insurance Fund must offer workers' compensation insurance to any employer requesting it, making the Fund an "insurer of last resort" for employers otherwise unable to obtain coverage.
Status Quo Ante
(WCB) - Latin phrase meaning "that which existed before" -- used to signify that a claimant's health has returned to what it was before the occurrence of the accident.
Stay
Under WCL section 23, when a party files an application for review from a WCLJ decision, the portion of the award that is under appeal is 'stayed'. For example, if a carrier appeals the WCLJ finding of total disability, but its consultant says moderate disability, then during the appeal the carrier must pay the conceded moderate rate, but need not pay at the total rate. Even if the carrier loses the appeal, it should not be penalized for late payment under sec. 25(3)(f). Awards are, however, subject to interest per section 20. Once the Board Panel issues its Memorandum of Decision (MOD), if the carrier loses, it must pay the award directed by the Board Panel. If the losing party appeals an MOD to the Appellate Division, Third Department, and/or files a request for Full Board Review, there is no stay on the awards rendered in the MOD. For example, if the carrier lost the appeal, and the MOD directed payment at the total rate, and the carrier filed a request for Full Board Review and/or a notice of appeal to the Appellate Division, it is not allowed to withhold payment pending resolution of that/those application(s). There is no stay following an MOD. There is one exception to this rule. If the MOD is not unanimous, in other words if there is a dissenting panel member, then if the losing party seeks Full Board Review, this is called mandatory Full Board Review, and there is probably a stay on awards rendered in that MOD. This is extremely rare. Well over 99% of all MODs are unanimous. In the event of a dissent, and a request for mandatory Full Board Review, OOA will make sure that the claims examiner is properly informed of this in the case note.
Subrogation
(WCB) - The assignment of a cause of action against a third party by the claimant to the carrier. If cause for an action (e.g., a product liability lawsuit) against a third party exists based on a work injury or illness, and the claimant fails to commence such action within the period specified by Section 29 of the Workers' Compensation Law (6 months after the awarding of compensation or 9 months after the enactment of new laws permitting additional remedies), the failure operates as an assignment of the cause of action to the insurance carrier liable for the payment of compensation benefits.
Subsequent Report of Injury (SROI)
A record of an event sent to the WCB that completes a subsequent report of injury requirement.
Survey of Occupational Injuries and Illnesses
(BLS, DOL) - An annual national survey by the Bureau of Labor Statistics that collects data from a random sample of 250,000 establishments, representing most of private industry (the survey excludes the self-employed, mines, railroads, farms with 10 or fewer employees, private households and Federal, State and local government agencies; mine and railroad data are reported separately to the BLS and reported with the survey results). Data for the program are obtained from logs and supplementary records that establishments maintain throughout the reference year.
Suspend
(Compliance) - To temporarily halt action to collect a penalty against an employer; to prevent the Process Control function of the Insurance Compliance system from sending periodic notices to an employer who is or has been out of compliance with Workers' Compensation Law. Employers' files are suspended to allow time for the Redetermination Unit to consider changing the penalty or to await information from the employer.
Sweep Benefit
(eClaims) - A previously paid benefit that is reported on a SROI transaction but is not the Benefit Type specifically associated with the current SROI transaction. Only a limited amount of benefit information is required to be submitted by the Claim Administrator for a Sweep Benefit.
Symptomatic Treatment
Medical treatments aimed at providing relief from the symptoms of a disease or injury, rather than providing a permanent remedy to the underlying condition.
Tentative Rate
(WCB) - A weekly rate assigned by the Workers' Compensation Board for carrier indemnity payments, pending final adjudication of outstanding issues relating to benefit rates.
Third Party Administrator
(WCB) - A person, firm, corporation or insurance carrier licensed by the Workers' Compensation Board to solicit the business of representing self-insurers in dealings before with the Board.
Third Party Settlement
(WCB) - This term refers to lawsuits against equipment manufacturers, facility owners and other non-employer parties whose products or services contributed to the occurrence of an accident. Under workers' compensation law, a compensation claim is a worker's sole remedy against the employer, but lawsuits may be initiated against third parties for contributory negligence, product defects, etc.
Token
In a computer database, a single word used to search for information
Trading Partner
A trading partner is an entity that enters into an agreement with the WCB to exchange data electronically. A trading partner can be an insurance company, licensed third party administrator or self-insured employer.
Transport
(Compliance) - On the Insurance Compliance system, to move information from one record to another. Employer information and employer coverage information can be transported.
Trustee
A person who supervises a trust for the benefit of another person
T/A
Abbreviation for Trading As; means the same as Doing Business As
UC
(Compliance) Abbreviation for Uncollectible Penalty
UEF
See Uninsured Employers' Fund
UIER
Abbreviation for Unemployment Insurance Employer Registration number; assigned by the NYS Department of Labor (DOL) to identify an employer. Appears as a seven-digit number, such as 26-41857.
Unemployment Insurance Employer Registration (UIER) number
An identification number the NYS Department of Labor (DOL) issues to employers required to contribute to Unemployment Insurance.
Uninsured Employers' Fund (UEF)
A unit of the Workers' Compensation Board that pays compensation claims to employees when their employers have no Workers' Compensation insurance. The UEF is funded by penalties collected from employers that fail to maintain Workers' Compensation coverage.
VAWBL
see Volunteer Ambulance Workers Benefit Law.
VFBL
see Volunteer Firefighters Benefit Law.
Video Conferencing Guidelines
Tips, Techniques, & Etiquette for Successful Video Conferencing
Vocational Rehabilitation
A structured process designed to improve the employment potential of a person whose earnings potential have been reduced by injury, disease, prolonged absence from the work force or other events. Vocational rehabilitation services may include counseling, vocational evaluations, assisted job search, trial placement in a job, on-the-job training, vocational or academic schooling, job modification, workplace redesign, transportation services, etc.
Volunteer Ambulance Worker
(eClaims) - identified on the FROI transaction by the Employment Status Code (DN0058) of “9” (volunteer) and Manual Classification Code (DN0059) of “7730” (volunteer ambulance worker). The name of the Ambulance Service can be found under the Insured Name and the name of the Political Subdivision/Fire District can be found under Employer Name.
Volunteer Ambulance Workers Benefit Law (VAWBL)
Chapter 64-b of the Consolidated Laws, the basic New York State law covering work-injury compensation benefits for volunteer ambulance workers.
Volunteer Firefighter
(eClaims) - identified on the FROI transaction by the Employment Status Code (DN0058) of “9” (volunteer) and Manual Classification Code (DN0059) of “7711” (volunteer firefighter). The name of the Fire Company can be found under the Insured Name and the name of the Political Subdivision/Fire District can be found under Employer Name.
Volunteer Firefighters Benefit Law (VFBL)
Chapter 64-a of the Consolidated Laws, the basic New York State law covering work-injury compensation benefits for volunteer firefighters.
Wage
see Average Weekly Wage.
Wage Expectancy
(WCB) - A decision element assigning an artificial wage rate to a young claimant, based on the authority of Section 14(5) of the Workers' Compensation Law: "If it be established that the injured employee was under the age of twenty-five when injured, and that under normal conditions his wages would be expected to increase, that fact may be considered in arriving at his average weekly wage".
Waiting Period
(WCB) - Period covering the first 7 days of disability resulting from a work-connected injury or illness. Workers' compensation indemnity benefits are not allowable for the first 7 days of disability, except that (a) in cases where the disability period exceeds 14 days, indemnity awards are allowed from the date of disability,(b) under a plan or agreement accepted by the Chair, the waiting period may be less than 7 days or eliminated entirely and (c) there is no waiting period for (VAWBL/VFBL) cases covering volunteer ambulance workers or volunteer firefighters.
Walk-In Stipulation Calendar (WISK)
Hearings are not pre-scheduled; parties "walk in" on the designated day and present to the Judge a resolution of the case by stipulation of the parties. Judge hears and rules on the stipulation, and, if appropriate, closes the case.
WC
(Compliance) - The part of the Insurance Compliance computer system maintained by the Employer Coverage Unit and containing records of insurance coverage for employers who are or may become subject to the requirement to have Workers' Compensation insurance
WCB
see Workers' Compensation Board
WCL
see Workers' Compensation Law
WCRI
see Workers' Compensation Research Institute
Web Data Entry Application (eClaims)
A secure data entry application on the WCB website for Claim Administrators who are not utilizing Flat Files to submit FROI and SROI transactions to the WCB. The transaction must still be accepted by the WCB to be considered received by the WCB. The Web Data Entry Application will typically be utilized by smaller companies that submit lower volumes of claims.
Workers' Compensation Board, New York State (WCB)
(a) The agency charged with administering the Workers' Compensation Law, the Volunteer Ambulance Workers Benefit Law, the Volunteer Firefighters Benefit Law, and the Disability Benefits Law. (b) The thirteen-member board responsible, either directly or via review by delegated authority, for determining all issues involving claims under the Workers' Compensation Law. The members are appointed to seven-year terms by the governor, by and with the advice and consent of the senate. The governor designates a Board member as chair and another Board member as vice-chair.
Workers' Compensation Law (WCL)
Chapter 67 of the Consolidated Laws, the basic New York State law governing the workers' compensation system; separate laws cover compensation benefits for volunteer firefighters and volunteer ambulance workers. {except as noted, references to the Workers' Compensation Law in this glossary shall also refer to corresponding provisions under the Volunteer Firefighters Benefit Law and the Volunteer Ambulance Workers Benefit Law}
Workers' Compensation Law Judge
(WCB) - An officer appointed by the Workers' Compensation Board to hear and determine claims and to conduct such hearings and investigations and make such orders, decisions and determinations as may be required in the adjudication of the claims. A Judge's decision is deemed the decision of the Board unless the Board modifies or rescinds such decision.
Workers' Compensation Research Institute (WCRI)
An organization funded by insurance carriers that conducts research and data reviews relating to workers' compensation issues on a national and a state-by-state basis.