Workers' Compensation
This type of benefit is provided to workers who are temporarily unable to perform any work due to a job-related injury or illness for up to 2 years.
What is Temporary Total Disability (TTD)?
What type of treatment does a Unimodal patient receive?
Cognitive Behavioral Treatment (CBT)
What does CBT stand for?
Cognitive Behavioral Therapy
What are the 3 categories in the treatment approach used by IOH?
Biological, Psychological, Social Influences
If an RFA is denied through utilization review, the injured worker can appeal through this independent process.
What is Independent Medical Review (IMR)
This act underpins the workers' compensation system in California, ensuring no-fault coverage for injured employees.
What is the Workers' Compensation Bargain Act?
What does FRP Stand for?
Functional Restoration Program
These two acronyms refer to physicians responsible for managing and supporting an injured worker’s care: one as the primary provider and the other as a supporting provider?
What are PTP (Primary Treating Physician) and STP (Secondary Treating Physician)?
A process used by insurance companies to decide whether to approve medical treatments recommended by a physician.
Utilization Review (UR)
What is a medical evaluation conducted to determine the extent of an injured worker's physical disability, assessing their condition, treatment needs, and ability to work?
Multidisciplinary Evaluation (This is a qualifier for FRP and CRPS programs)
In exchange for guaranteed benefits under the Bargain Act, employees forfeit this right in most cases.
What is the right to sue the employer for negligence?
What does CRPS stand for?
Complex Regional Pain Syndrome
Give me four out of the seven stackholders in Workers' Compensation system?
1.Employees
2.Employers or Employer Representative
3.Insurance Companies
4.Medical Providers
5.Government agencies
6. Applicant Attorney
7. Defense Attorney
The point at which an injured worker's condition has stabilized and is unlikely to improve further with medical treatment.
Maximum Medical Improvement (MMI)
A medical status indicating that an injured worker has reached Maximum Medical Improvement (MMI)—their condition is stable and unlikely to improve further with treatment.
P&S (Permanent and Stationary)
What is a set of regulations found in title 8, California Code of Regulations section 9792.20 through 9792.27. 23 that contain medical treatment guidelines and rules for determining what is reasonable and necessary medical care. (ref. California Department of Industrial Relations)
Medical Treatment Utilization Schedule (MTUS)
What does IOP mean?
Intensive Outpatient Program
What are our programs(BIP, FRP,PTSD IOP) PTSD IOP (IOP as a way to distinguish them)
Who is one WCOMP stakeholder coordinating patient care and approval for patients outside of IOH?
What is an Adjuster
A doctor certified by the state to assess an injured worker's condition and provide an independent medical evaluation.
Qualified Medical Evaluator (QME)
A type of settlement where the worker receives a lump sum payment and closes the claim.
Compromise and Release (C&R)
After initial Industrial Injury Occurs, what report does the occupational medicine physician create? Why is this document so important for the patient and other medical providers?
1. DFR- Doctors First Report ( PR1 - this is the DFR)
2. ABP- Approved Body Part defines medical treatment, determines disability benefits, guides rehab and more
This approach integrates multiple disciplines working collaboratively with shared goals and blurred professional boundaries. This is the primary method of communication among team members to create a cohesive care plan.
What is the transdisciplinary approach?
What are three different tracks patients leave IOH?
P &S Discharge
TOC- Transfer of care
C & R-
This legal standard is used to determine whether an injury is work-related and qualifies for workers' compensation benefits.
What is AOE/COE (Arising out of and occurring in the course of employment)?
This formal request is submitted by a treating physician to seek approval for medical treatment under California workers' compensation.
What is a Request for Authorization (RFA)?