The Alphabet Soup that is Workers Compensation in Montana.

Workers’ Compensation, like many governmental programs, has a long list of acronyms.  Below is a list of some of the most commonly used acronyms in the Workers’ Compensation system along with a brief informal definition of the term.  The official definitions of these terms are located in the Workers’ Compensation Act.  The Definitions section for the Workers’ Compensation Act is located in Section 39-71-116, MCA.

AWW: Average Weekly Wage, is determined by using the average of the four previous pay periods of the injured employee.  The AWW is used to determine the Temporary Total Disability Rate as well as the Permanent Partial Disability rate.

COLA: Cost of Living Adjustment, is an inflationary based increase in benefits to workers who are entitled to Permanent Total Disability benefits. 

DLI: Department of Labor and Industry, is a department of Montana that has jurisdiction over the workers’ compensation system.  In addition to the workers’ compensation system, the DLI has a number of other programs that focus on Montana’s workers.

ERD: Employment Relations Division, the ERD is a division of the Montana Department of Labor and Industry.  If a claimant has a dispute with the insurance carrier, the ERD assigns a mediator to hear both sides of the dispute and issue findings.  In addition, the ERD is responsible for processing the FROI described below and confirming whether an employer has workers’ compensation insurance coverage.

FROI: First Report of Injury, the FROI is the form employers submit to the insurer following a claim for benefits.  The FROI must be signed by the injured worker (if possible) and its contents must be carefully reviewed by the claimant and any dispute noted prior to filing the FROI.

MMI: Maximum Medical Improvement, is the point at which additional medical treatment would not materially improve the injured worker’s medical condition.  

MSA: Medicare Set-Aside, under federal law, Medicare is allowed to require reimbursement from workers’ compensation providers for payment of medical bills made by Medicare that have occurred and will likely occur in the future.  An MSA is required whenever a workers’ compensation claimant is eligible (or will soon be eligible) for Medicare benefits related to the industrial injury.  The MSA must be reviewed and approved by CMS (another federal government agency) before a settlement can be approved.

OD: Occupational Disease, is a physical condition that develops over more than a single work shift.  An OD claim has a different statute of limitation than an injury claim.

PPD: Permanent Partial Disability, is covered under Section 39-703, MCA, and occurs when a claimant, although able to return to work, realizes a wage loss as a result of an industrial injury or occupational disease.  The claimant must also have a physical impairment rating before being eligible for PPD benefits.

PTD: Permanent Total Disability, occurs after a claimant reaches MMI and is unable to return to any gainful employment.  PTD designation allows a claimant to receive medical treatment for more than 60 months after the date of injury and allows the claimant to be eligible for Cost of Living Adjustments.

SOL: Statute of Limitations, the time in which a claimant is required to file a claim.  A claimant who suffers from an industrial injury must report the injury to his employer within 30 days of the injury.  A claimant who suffers from an occupational disease has one year to provide written notice to the employer, insurance carrier, or the DLI.  In any event, written notice must be provided to the employer, the insurance carrier or the DLI within one year unless extenuating circumstances allow for a maximum of 24 months in any case.

SSDI: Social Security Disability Insurance, is a federal program that allows qualifying individuals to receive cash benefits if the individual is unable to return to gainful employment.  SSDI is important in the workers’ compensation setting in Montana because insurance carriers in Montana are allowed to reduce the benefits they pay for TTD or PTD benefits if a claimant receives SSDI benefits.  

TPD: Temporary Partial Disability, is used to supplement pay for workers who, although they returned to work, are not earning as much as they earned (AWW) at the time of injury.

TTD: Temporary Total Disability, occurs when a claimant, as the direct result of an industrial injury or occupational disease is temporarily unable to return to the position held at the time of injury.  TTD designation continues until the claimant reaches MMI and it is determined that the claimant cannot return to any type of work.  

UEF: Uninsured Employers Fund, is part of the DLI set up to provide workers’ compensation benefits for injured workers whose employers did not have workers’ compensation insurance coverage.  The UEF is entitled to reimbursement from uninsured employers and also entitled to receipt of a penalty from that employer.