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Commonly Used Abbreviations in Florida Workers' Compensation Cases

AHCA (Agency for Health Care Administration) = A governmental agency of the State of Florida, which claims to champion accessible, affordable, quality health care for all Floridians -- Managed Care Arrangements fall under its jurisdiction

AWW (Average Weekly Wage) = The number representing the pre-accident earning power of an IW, which is usually based on the actual gross wages and fringe benefits received by the IW during the 13 calendar weeks prior to the date of accident

CMS (Centers for Medicare and Medicaid Services)

DOAH (Division Of Administrative Hearings) = A governmental agency of the State of Florida, which oversees the OJCC -- DOAH is part of the executive branch, not the judiciary

DWC-25 = A two-page form published by the Division of Workers' Compensation that doctors are required to complete after each medical evaluation to advise the IW and the E/C of the patient's updated work status, referrals to specialists, and assignment of MMI/PIR

E/C (Employer/Carrier) = The collective reference for the IW's employer and its workers' compensation insurance carrier. This is sometimes also seen as E/C/SA

E/SA (Employer/Servicing Agent) = The collective reference for the IW's employer and the servicing agent or third-party administrator handling claims for the employer's workers' compensation insurance carrier. This is sometimes also seen as E/C/SA

EMA (Expert Medical Advisor) = A medical specialist appointed as an expert witness by the JCC to resolve a conflict of opinions between other medical providers (usually IMEs)

HNP (herniated nucleus pulposus) = A slipped disk along the spinal cord -- HNPs occur when all or part of the soft center of a spinal disk is forced through a weakened part of the disk

IIB (income impairment benefits) = The class of wage-loss benefits paid to an injured worker upon reaching MMI -- IIBs are paid according to a statutory schedule that is based on the injured worker's PIR -- These are sometimes referred to as PPDs, or permanent partial disability benefits

IME (independent medical examination or examinator) = A medical specialist used as an expert witness to help resolve a dispute in existing medical opinions -- Each party to a workers' compensation claim is entitled to one IME per accident -- Conflicts between IMEs can be resolved by an EMA

IW (injured worker) -- This abbreviation is used mostly by adjusters. Once a PFB has been filed, injured workers are almost always referred to as "claimants," because, at that point, the injured worker has filed a claim.

JCC (Judge of Compensation Claims) = The administrative judge assigned by the OJCC to rule on all claims for benefits in a workers' compensation claim

L/S (lumbar spine)

MCC (Managed Care Coordinator) = The doctor assigned under a WCMCA as the IW's PCP

MCC (major contributing cause) = A legal standard employed to determine liability for the medical benefits claimed. For dates of accident after 10/1/03, MCC is defined as that cause which is more than 50 percent of the current need for treatment when compared with all other causes combined. If the work accident is not the MCC of the need for treatment, then the E/C will not be held responsible for payment

MMI (maximum medical improvement) = The date after which it is no longer reasonably foreseeable that the injured worker is likely to improve medically -- Upon reaching MMI, the IW's doctor is required to assign a PIR - The IW's temporary benefits then convert to permanent benefits, and the E/C is required to pay either IIBs or PTD benefits

MSA (Medicare Set-Aside) = Federal regulations require that any IW who settles his/her w/c case must protect Medicare's interests by setting aside a portion of the settlement funds that is approximately the amount CMS believes the w/c carrier would have spent on Medicare-covered expenses, had the case not been settled. "MSA" usually refers to that amount of money, which is most often placed in a trust account on behalf of the IW. MSAs are not needed in every case. CMS has issued guidelines on when an MSA trust should be set up.

OJCC (Office of Judges of Compensation Claims) = The Florida administrative agency that oversees workers' compensation claims. The OJCC is part of DOAH.

PCP (primary care provider) = A doctor who serves as a "gatekeeper" to other medical services and providers, including specialists

PFB (Petition For Benefits) = The formal document filed with DOAH to initiate litigation over a claim for benefits -- PFBs are considered pleadings and are the workers' comp equivalent of a court "complaint" or lawsuit, except that more than one can be filed in any given case

PIR (Permanent Impairment Rating) = The numerical rating assigned (as a percentage, from zero upwards) by a doctor to estimate the amount of residual damage an IW has suffered as a result of the work accident -- IIBs are calculated using the PIR and the AWW

PICA (Penalties, Interest, Costs, Attorney's fees) = This acronym is commonly used in carrier responses to PFBs, basically to save typing. The usual context is that the adjuster will respond to individual claims for penalties and interest on late indemnity payments and separate claims for fees and costs by collectively denying them all with the line: "No PICA due or owing."

PTD (permanent total disability) = The class of wage-loss benefits an IW is eligible for when medical evidence supports the conclusion that the IW will not be able to return to work permanently. The current statutory standard for PTD is that the IW must establish that s/he is not able to engage in at least sedentary employment, within a 50-mile radius of his/her residence, due to his/her physical limitations.

P/T (physical therapy)

RTW (return to work) = An indication that the IW is medically able to return to work after having been on TTD status -- Work status is usually described as being Full Duty (i.e., no restrictions), Medium Duty (minor restrictions), Light Duty (moderate restrictions), and Sedentary Duty (severe restrictions; usually no lifting allowed)

TPD (temporary partial disability benefits) = The class of wage-loss benefits an IW is eligible for when he or she has been released by a doctor to return to work is not yet at MMI -- TPDs are usually paid at 64% of the IW's AWW but can be reduced based on actual wages earned and other offsets

TT/TP = The collective abbreviation for "temporary total and/or temporary partial disability benefits" -- These benefits stop after the IW reaches MMI or after 104 weeks of TT/TP have been exhausted, which ever comes first

TTD (temporary total disability benefits) = The class of wage-loss benefits an IW is eligible for when a doctor places him or her on No Work status as a result of a compensable work injury or condition -- TTDs are usually paid at 66-2/3% of the AWW

WCMCA (Workers' Compensation Managed Care Arrangement) = WCMCAs are similar to HMOs but are overseen by AHCA -- IWs must exhaust all grievance procedures under an MCA before he or she can file a PFB (and invoke the jurisdiction of the JCC)

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Kenneth B. Schwartz, Esq., represents employers, insurance carriers, and aggrieved individuals in litigation, trials, and appeals of business and employment matters, including contract disputes, enforcement of noncompete and trade secret agreements, allegations of wrongful termination and discrimination, workers' compensation claims, Rule Nisi enforcement proceedings, resolution of stop work orders and premium disputes, and construction defect litigation.

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