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Term
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Definition
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date of injury (DOI)
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date a specific injury occurs or, for cumulative injuries or occupational disease, the date of partial or total incapacity to work
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de novo review
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in an appeal of a WC decision, a board, commission, or court that makes a de novo review can make a new determination without considering the initial finding; de novo review is the standard in some states but not in others
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death benefits
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funeral benefits, subject to a maximum limit in the WC statutes, as well as wage replacement benefits for relatives who were partially or wholly dependent on the worker's income, also subject to state maximums – wage replacement benefits generally end when a spouse remarries or when the youngest child reaches age 18 (25 if still in school), whichever is later
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death certificate
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legal document issued by a state or county confirming the death of an individual
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Death on the High Seas Act (DOHSA)
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the wrongful death provisions of the Merchant Marine Act of 1920
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debit
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for experience rating, an increase in (debit) the premium paid due to an experience modification factor greater than 1.0 (loss experience is worse than that of similar employers)
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dec page, dec sheet
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see information page
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deductible
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see large deductible plan and medical benefit deductible - these are deductibles paid by the employer; for WC, the worker does not typically pay any medical deductible
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default
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For WC, a default of the employer does not prevent payment of benefits by the insurer
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Defense Base Act (DBA)
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WC coverage for private employees working on US defense bases or supporting war efforts; claims handled within the Longshoremen’s & Harbor Workers Compensation Act federal system
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Defense Base Act Coverage Endorsement
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endorsement providing Defense Base Act (DBA) coverage
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dependency benefits
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same as death benefits
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dependent
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employee's family member who was wholly or partly dependent upon the employee's earnings at the time of the employee's injury, disease, or death (same as survivor)
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deposit premium
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for retrospectively rated WC plans, the initial premium paid
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developed losses
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for underwriting purposes, raw losses adjusted to reflect inaccuracies in reserves of known losses, losses which have occurred but have not yet been reported, and closed claims likely to reopen
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deviation from scope
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for WC, a situation where compensability is questioned because the worker engaged in activities not related to the job
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diagnostic related groups (DRGs)
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groupings of related hospital procedures for purposes of medical billing; outpatient medical providers use Physicians Current Procedural Terminology (CPT) codes
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direct writer
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insurer that does not work through independent insurance agents or brokers (agents for direct writers are employees of the insurer)
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director
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a member of a board of directors who is not automatically eligible for WC benefits
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disability management
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for WC, strategies and tactics designed to promote an early return to work and maximum medical improvement
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discount from charges
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older method in use in some states to determine reimbursement rates for medical procedures
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disfigurement
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impairment of or injury to the beauty, symmetry, or appearance of a person that renders the person unsightly, misshapen, imperfect; or, a detrimental change in the external form of the person
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disfigurement benefits
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some states allow benefits specifically for scarring or other disfigurement; the basis for awarding such benefits varies widely
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district
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specific geographic area within a WC system
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dividend plan
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premium refund plan, calculated after policy expiration, based on the overall favorable performance of the insurer or of a group of policyholders, or an individual employer (dividends cannot be guaranteed in advance although they are often shown on proposals for insurance)
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domestic
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older term for residence employee
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domestic sovereign
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federally recognized American Indian tribe, pueblo, or nation-- under the US Constitution, such a group has sovereign rights to self-governance, including in workers compensation matters
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Domestic and Agricultural Workers Exclusion Endorsement
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exclusion endorsement to a WC policy sometimes used in states where residence employees, agricultural workers, and casual employees are covered by the WC law
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domestic worker
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older term for residence employee
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downcoding
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for WC, assigning a different CPT code to reduce the rate of reimbursement
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drug testing
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for WC, some employers use post-accident drug tests to screen for possible influence of alcohol use or illegal drug use (employers should consult a labor law attorney before instituting such policies)
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drug use
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for WC, injuries that occur while the worker is under the influence of illegal drugs raise compensability issues
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dual capacity claim
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for WC, a civil suit alleging that the employer had more than one legal relationship with the employer (e.g., an employee of a soft-drink bottler is injured by the employer's product consumed during non-work hours)
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dual purpose trip
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for WC, a trip where the worker performs non-work actions as well as duties for the benefit of the employer (e.g., an employee who makes a bank deposit for the employer on her way home) – same as special errand rule
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dueling docs
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slang term referring to a battle of independent medical examiners, each of whom tries to provide more persuasive opinion about a WC case than other independent medical examiners for that claim
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duty to cooperate
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WC insurance policy requirement that the employer cooperate with the insurer’s claim investigation and resolution
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duty to give notice
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WC insurance policy requirement that the employer timely notify the insurer of new claims and certain changes in risk exposure
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