Division of Longshore and Harbor Workers' Compensation (DLHWC)
Chapter 0-601 — GLOSSARY
Purpose and Scope. This Chapter provides definitions of
certain terms used in the LHWCA PM. In some cases, these definitions may differ
slightly from legal definitions in current use.
Exclusions. Generally, this chapter does not contain terms
that are defined in section 2 of the Act or in the regulations, or which are
defined or extensively discussed in the LHWCA PM. The word index (located in
the Preface) may be useful in locating definitions or discussions of such
terms.
Terms.
Abnormality. Describes a function which is no longer within the
normal range in either of two dimensions. Abnormality can result from a
quantitative loss of function or from a qualitative change in functional
capacity. Reduced range of motion is a quantitative abnormality. Tremor, spasm,
rigidity, hallucinations, etc., represent qualitative changes.
Act. The Longshore and Harbor Workers' Compensation Act, as
amended and extended by the DCCA, DBA, OCSLA, and NFIA.
Acupuncture. The Oriental practice in which needles are inserted
into specific peripheral nerves to relieve the discomfort associated with
painful disorders, to induce surgical anesthesia, and for therapeutic purposes.
Acupuncturists are not considered physicians under the LHWCA, but the treatment
may be approved if authorized by a duly qualified physician.
Anatomical Abnormality. A visible abnormality in tissue formation
or growth. Scars, disfigurement, and joint disease are all examples of an
anatomical abnormality. Visibility can be attained through x-ray, CAT scan, and
other tests.
Appeal. The process of seeking review by the Benefits Review
Board of a decision and order issued by an Administrative Law Judge or, under
certain circumstances, of a compensation order issued by a District Director.
The term is also used to refer to the process of seeking review of a final
order of the Benefits Review Board in the U.S. Court of Appeals for the circuit
in which the injury occurred. In DBA cases where the injury did not occur
within any "circuit," the appellate jurisdiction is in the circuit that
includes the OWCP district where the claim was filed.
Claims Examiner. An employee of the OWCP having special training
and experience in the field of claims adjudication under the specific act to
which the Claims Examiner is assigned.
Compensation Order. A legal document in connection with a
compensation case. Issued over the signature of an Administrative Law Judge or,
under certain situations, over the signature of the District Director, acting
as a Deputy Commissioner, the order describes the findings of fact and either
makes the award or denies the claim. A compensation order may be the subject of
a direct appeal to the Benefits Review Board.
Compliance. Conformity of an employer or insurance carrier with
the provisions of the Act. On the part of the employer this may include
obtaining required insurance coverage, posting a notice of insurance coverage,
and reporting injuries specified by the law. On the part of the insurance
carriers, the term includes payment of benefits, providing for medical care,
issuing a coverage card to the DO, or reporting and making payment of the
company's assessment under section 44.
Controversion. A formal denial of responsibility under the Act by
an employer or insurance carrier. The denial may be based on the belief that
the injury did not occur in the course of employment or did not fall within the
coverage of the LHWCA, or for other reasons. In essence the employer or carrier
is refusing on the basis of legal merit to accept liability or the asserted
extent of liability voluntarily. The denial also relieves the employer or
insurance carrier of a 10 percent penalty, provided the controversion is made
within the time specified by section 14(d) of the Act. In brief, controversion
is a denial by the EC of a claimant's right to compensation (or compensation
beyond an admitted amount).
Determinative Audiogram The “determinative audiogram”
is that test which is determinative of the disability for which the Claimant is
being compensated.
Disability. The term is defined in section 2(10) of the LHWCA. It
is important to note that, with certain exceptions, disability is an economic
concept, and not solely a medical concept. (Also see "Impairment.")
Dispute. A contested issue with respect to an essential element
of a compensation claim; or, as used informally, any question or difference
with regard to the entitlement or amount of compensation due a claimant,
medical treatment, etc.
Eligibility/Entitlement. As used throughout the LHWCA PM,
"eligibility" refers to the benefits and services which may be made available
to an injured worker or his/her dependents. Through the evaluation/adjudication
process, a determination is made regarding specific benefits to which an
injured worker is entitled. "Entitlement" is one of the end products of the
evaluation/adjudication process.
Evaluation/Adjudication. The process by which the CE, DD, or the
ALJ may determine the rate, duration, or type of specific benefit or service to
which a beneficiary is entitled and must receive.
Filing. The submission of forms or records to the OWCP within a
time period required by the various sections of the Act.
Functional Abnormality. Describes a condition in which the
physiological function is abnormal. Pain, tremors, and difficulties in speech
secondary to brain lesions are examples of functional abnormality.
Functional Loss. Describes a situation in which a physiological
function can no longer be performed by the individual. It should be measured in
quantifiable terms. A loss need not be absolute; it can be partial. Loss of
joint movement is an example of functional loss.
Impairment. The loss, loss of use, or derangement of any body
part, system or function. Impairment does not necessarily equate to disability
since an individual could have an impairment but not be disabled from work.
Statutorily, however, disability means impairment in the case of retiree
occupational disease cases and hearing loss cases.
Impartial Specialist. A physician, usually a medical doctor of
outstanding capability and often certified in a specialty by a national board,
selected to perform a medical evaluation or provide treatment of an injured
employee when a medical question has arisen.
Informal Conference. A meeting or telephone conference scheduled
by the OWCP at which the employer and/or insurance carrier or their
representatives are in attendance with the injured party or the claimant and/or
his/her representative for the purpose of resolving any outstanding
claim-related issue. The meeting is conducted by the CE or DD.
Loss of Wage-Earning Capacity. A computation of economic loss
which takes into consideration a claimant's age, degree of disability,
education, work history, training, and the availability of work in the area in
which the claimant lives. Payment of compensation based on such computation may
continue for the life of the claimant. However, if the employment-related
condition causing such a loss remains temporary, benefits are restricted to
five years.
Lost-Time Injury Report. Form LS-202 entitled "Employer's First
Report of Accident or Occupational Illness" concerning a job-related injury or
illness which causes the loss of one or more shifts of work.
Permanent. A descriptive term for a medical condition indicating
that it has become static or well stabilized and that it is not expected to
remit within a normal, predictable period despite medical treatment.
Permanent Partial Disability. A job-related physical or mental
disability which is permanent in nature but it is established that the employee
is capable of earning wages (i.e., it is established that the employee is
working or that there are realistically available job opportunities within the
geographical area where the employee resides which he or she is capable of
performing, considering the employee's age, education, work experience, and
physical restrictions, and which the employee could secure if he or she
diligently tried). In cases of “scheduled” permanent partial
disability, the actual loss of earning capacity is irrelevant as long as it is
less than total.
Permanent Total Disability. A job-related physical or mental
disability which is permanent in nature and renders the employee incapable of
earning pre-injury wages at the same work as at the time of injury or in any
other employment. A prima facie case of total disability is established where
the employee shows that he or she cannot return to his or her regular or usual
employment due to the work-related injury.
Schedule Award. A payment of compensation for job-related injury
resulting in permanent impairment of a scheduled member of the body defined by
section 8(c)(1)-(20) of the LHWCA.
Secretary. The Secretary of Labor, or his or her designee, or the
person who has been delegated the authority to act for and on behalf of the
Secretary.
Subrogation. The right of one who has paid an obligation for
which another has primary liability to be indemnified by the other (e.g., where
a case results in an employee's receipt of compensation under an award which
includes disability due to malpractice, an insurance carrier may have
subrogation rights to the recovery of the employee against the physician, but
limited to the amount actually paid by the carrier or for which it has become
liable because of the malpractice).
Temporary Disability. This term refers to a situation in which
the individual is incapacitated to perform his or her regular work because of
an anatomical or functional abnormality or loss, but where it is expected that
recovery merely awaits a normal healing period.
Temporary Partial Disability. A job-related physical or mental
disability which is temporary in nature and renders the injured employee unable
to perform the full duties of his or her regular job, but can perform some of
the duties of his or her job or can perform the duties on a less than full-time
basis, or can perform other suitable work during the recovery period and such
limited, part-time, or alternative work is actually reasonably available to him
or her. Compensation payments are limited to a maximum of five years.
Temporary Total Disability. Differs from temporary partial
disability in that the employee is totally disabled and cannot perform the
duties of his or her job.
Third Party. A party or individual who is neither the claimant
nor the employer, who causes the injury or disability to the employee,
entitling the employee or his or her survivors to pursue a suit, claim or
action to recover damages.
Third Party Suit. A legal action usually instituted by the
injured party against a party, other than the employer, whose tort against the
employee caused the compensable injury or death. The employee may pursue a
third party suit concurrently while receiving compensation from the employer or
insurance carrier.
