State News : Alabama

The WC world runs on abbreviations.  Seasoned WC veterans type three letters, hit send, and assume everyone knows exactly what they meant.  Sometimes they do.  Sometimes… not so much.

Every claim begins with a DOI (Date of Injury) or DOA (Date of Accident).  Shortly thereafter comes the FROI (First Report of Injury).  At this point, the ER (Employer) notifies the TPA (Third Party Administrator), who opens a file, and assigns a claim number.

The injured employee, now officially the IW or Clmt, wants to know one thing: “How much am I getting paid?”  The answer depends on the AWW (Average Weekly Wage), a number that will be debated, recalculated, and argued about far longer than anyone expected.  Then the ER wants to know if this is a MO (Medical Only) or LT (Lost Time) claim because it’s EMR (Experience Modification Rating) could be adversely affected.

Now we enter the medical phase.  This is where abbreviations multiply like gremlins after midnight.  The MP (Medical Provider), often an Ortho, prescribes Tx, Rx, PT, OT, and maybe some DME if things get spicy.  The Px provides their Hx where any ROM or LOC is reported.  If the MO orders Sx, you can bet that said request will be referred to UR (Utilization Review).

If treatment continues, the claim gets MM (Medical Management), possibly involving an NCM, FCM, or TCM.  Meanwhile, work status bounces between FD, LD, OW, and RTW, with Mods attached.  Everyone is now holding their breath for MMI (Maximum Medical Improvement) aka the finish line that always seems to move.  Then someone may request an IME or FCE.

Once MMI hits, the doctor assigns an IR. This number decides whether we’re talking PI, PPD, PPI, or the nightmare scenario, PTD which is likely based on a VDR (vocational disability rating).  If PTD, then SSDI offsets become relevant.

Just when everyone finally memorized the acronyms, along came EDI (Electronic Data Interchange) to remind us that things can always get more complicated.  In theory, EDI was supposed to streamline claims reporting.  In practice, it introduced a parallel universe where the claim is “accepted” in real life but “rejected” by the system because someone used the wrong two-letter jurisdiction code, forgot a decimal in the AWW, or dared to list a DOI that offended the EDI gods. 

Next comes the lawyers.  This is where the acronyms start emailing each other.  The DA (Defense Attorney) exchanges pleasantries with OC or PA/CA.  Everyone watches the SOL like a hawk.  In Alabama, for a WC settlement to achieve finality, it must be court approved or an Ombudsman must hold a BRC (Benefit Review Hearing) and sign off on it.  

Oversight comes from the WCB/WCC or IC, depending on the state. In Alabama, it is the ADOWFWD (Alabama Dept of Workforce Workers’ Comp Div).  If Medicare is even remotely involved, MSP compliance becomes a thing, CMS enters the conversation, and suddenly someone asks whether an MSA is needed, usually on a Friday afternoon.

So, the next time you see an email that says: “IW at MMI, IR pending, OW w/ Mods, UR approved Tx, DA evaluating PPD exposure” - Just smile.  You’re fluent now.  You’re welcome!

About the Author:

This article was prepared by Mike Fish, an attorney with Fish Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers and funds, and third-party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this article or Alabama workers’ compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com  or by calling him directly at 205-332-1448.