Historians Basic Terminology

Basic Terminology

As a historian, it is critical that you become familiar with the terminology used in med-legal reports. By identifying this terminology, you will be able to: 1) Explain your role as a historian. 2) State the importance of an accurate history report. 3) Implement understandable terminology when interacting with patients. 4) Apply the correct terminology when completing history templates.

Introduction

This resource contains most of the terms you will encounter when completing the medical history template and reading advocacy/cover letters. Use the Navigation Arrows to move though the slides and see ther terms and their definitions. At the end of the slides, you will test you knowledge through a variety of questions.

Description

QME

A QME is a state-certified medical professional selected by the parties involved in a workers' compensation case to provide an unbiased evaluation of an injured worker’s condition. The QME is selected through a Panel List.

Qualified Medical Evaluation/Evaluator

AME

An AME is a doctor agreed upon by both the injured worker’s attorney and employer’s insurance representatives to evaluate a worker's medical condition and resolve disputes about the injury in workers' compensation cases.

Agreed Medical Evaluation/Evaluator

QMER

When the patient sees the QME for a follow-up.

Qualified Medical Re-Evaluation

PTP

Primary treating physician, this doctor usually refers the patients out to physical therapy, chiropractic treatment, or something else. They are the main physician in charge of treatment for the patient.

Primary Treating Physician

DOI

The specific date or date span of the injury in question. Sometimes cases can have multiple dates of injury.

Date(s) of Injury

DOE

The date that the patient will see the QME/Physician.

Date of Evaluation

DOB

Usually found in the demographics.

Date of Birth

EMP

Employer/Company where the patient in question was injured

Employer

AA

The attorney that represent the patient.

Applicant's Attorney

DA

The attorney that represents the insurance and/or the employer.

Defense Attorney

INS

The employer's insurance. Usually the insurance trhough which the patient receives care.

Insurance

Nature of Injury

The Nature of Injury can relate to whether the injury is classified as specific or cumulative: For a specific injury, the nature of injury describes the harm caused by a single, identifiable incident (e.g., a back sprain from lifting a heavy object once). For a cumulative injury, the nature of injury refers to harm that has developed over time due to repeated exposure or strain (e.g., carpal tunnel syndrome from repetitive typing).

Nature of Injury

SI

This is an injury that occurs due to a single, identifiable event, like a slip and fall, lifting a heavy object once, or an accident that causes immediate harm.

Specific injury

CT

This is an injury that results from repeated exposure to harmful activities or conditions over time, such as repetitive motions, continuous strain, or prolonged exposure to hazardous substances, which gradually cause wear and tear on the body.

Cumulative Trauma injury

Stakeholders

Key Parties involved in the workers' compensation claim: Injured worker Attorneys Insurance Carrier or Claims Administrator: Medical Providers

Stakeholders

Claimant

In California workers' compensation, the claimant is the injured worker who has filed a claim to receive benefits for a work-related injury or illness.

Claimant

Adjuster (Adj)

The adjuster is a representative of the insurance company or claims administrator responsible for managing and investigating workers' compensation claims, including evaluating benefits and arranging medical treatment.

Adjuster

Self-Represented Injured Worker

A self-represented injured worker is an employee who handles their own workers' compensation claim without the assistance of an attorney.

Self-Represented Injured Worker

Test your knowlegde

If you have any questions with respect to this training presentation, contact your department lead or email training@spectrumeval.com