Glossary of Workers’ Compensation Terms
An event, arising out of and in the course of employment that results in personal injury to the worker.
Accident, Notice and Causal Relation constitute the foundation of an accident claim and must be found by the New York State Workers’ Compensation Law Judge for the claim to be established.
A legal action taken by one of the parties to the Appellate Division, to reverse or amend a decision or direction made by a Board Panel or the Chair of the Workers’ Compensation Board.
Claimant attorney fees are set by the Workers’ Compensation Law Judge and are payable out of the cash award to the claimant. If no cash award is made, the claimant owes no attorney fee.
Average Weekly Wage (AWW):
Wage used to calculate total disability benefit rates for most claimants.
A request, on a prescribed form (C-3), for New York State Workers’ Compensation benefits for work-connected injury, occupational disease, disablement, or death (Form C-62). A claimant must file a claim within a two-year period from the occurrence of the accidental injury, knowledge of occupational disablement, or death.
Close a Case:
To remove a case from further consideration. A decision to close a case is based on a judge’s determination that no further rulings by the Board are necessary in the case. The closing date is the date of the hearing or the effective date of the decision. Although a case has been closed, the Board has continuing jurisdiction and can reopen the case at a later date.
A Workers’ Compensation Board process established to resolve, in an expeditious and informal manner (e.g. through meetings or telephone conferences), issues involving non-controverted claims in which the expected duration of benefits is fifty-two weeks or less.
A claim that is in dispute and in litigation.
A claim challenged by the insurer on stated grounds. The Board sets a pre-hearing for the determination of the grounds and directs the parties to appear and present their case.
Board 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.
A period of total wage loss and loss of earning capacity, beyond the statutory waiting period, caused by the claimant’s work-connected disability. If the disability period exceeds 14 days, compensation will be paid from the first day of disability.
Lump Sum Settlement:
A negotiated and Board-approved agreement, between a claimant with a non-schedule permanent partial disability and the insurer. As a result of the agreement the claimant receives a sum of money representing all future compensation for his/her disability, and the case is considered closed.
Maximum Medical Improvement (MMI):
An assessed condition of a claimant based on medical judgment that the claimant has recovered from the work injury to the greatest extent that is expected and no further change in his/her condition is expected.
Written notification from an employee to the employer, that a work-connected accident/injury has occurred. For accidental injuries, notice must be given no later than 30 days after the accident. In cases involving occupational diseases, the time period for notice is 2 years from the date of disablement or from the date when the employee knew, or should have known, that the disease was due to work.
Occupational Disease (OD):
A disease arising from employment conditions, 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 workers’ job.
Occupational Disease, Notice and Causal Relationship (ODNCR):
It must be established that the claimant has an occupational disease recognized by the WCB and the claimant has, after the onset of the disease, notified his/her employer within the statutory time limit (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 a causal relationship exists between work-related activities and exposure, the development of the occupational disease, and a subsequent disability.
Any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment. This includes acute and chronic illnesses or diseases that may be caused by inhalation, absorption, ingestion or direct contact.
Any injury that results from a work accident or other exposure involving a single accident in the work environment.
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-related injury.
A Workers’ Compensation case that 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.
The proportion of pre-injury wages replaced by Workers’ Compensation benefits.
Period covering the first seven days of disability resulting from a work-connected injury or illness. Workers’ compensation indemnity benefits are not allowable for the first seven days of disability, except in cases where the disability period exceeds 14 days, indemnity awards are allowed from the date of disability.