053-1 Wyo. Code R. §§ 1-3 - Definitions
(a) 49 CFR Part 40
means Title 49, Part 40 of the Code of Federal Regulations (CFR) as revised
January 1, 2018.
(b) AB Rated. Drug
products made by different distributors and/or repackagers that are considered
therapeutically equivalent based on demonstrated bioequivalence.
(c) Actively Seeking Work. For purposes of
benefit eligibility, a claimant is actively seeking work if the claimant
provides tangible evidence of the work search to the Division. Completion of
the work search form will be considered tangible evidence. The work search must
contain a minimum of five contacts per week over the course of a six week
period. The six (6) week period must be immediately preceding the date the
application is filed with the Division or immediately following the date the
application is filed with the Division. The contacts listed on the work search
must be made for work the claimant is reasonably qualified to perform and is
willing to accept. Actions that would be considered an active search for
employment include completing job applications, faxing or mailing resumes
(include proof), and/or visiting the employers in person. Claimant must contact
the employer he was working for at the time of injury to inquire if the
employer has work available within their medically documented
restrictions.
(d) Actual Monthly
Earnings.
(i) Income the employee was
receiving from all employment at the time of injury and which is lost due to
the injury, including:
(A) Actual value of
board, lodging, rent, or housing and per diem expenses to be included within
the actual wage as remuneration, if such board, lodging, rent or housing and
per diem is lost as a result of the injury;
(B) Commissions and bonuses;
(C) The average amount of overtime pay
received in the six (6) months before the injury or guaranteed by written
agreement between the employer and employee entered into before the
injury;
(D) Gratuities received in
the course of employment, from others than the employer, only when such
gratuities are received with the knowledge of the employer and reported to the
United States Internal Revenue Service by the employee or the
employer;
(E) Wages earned from
employment at more than one occupation or employer other than the employer at
the time of injury, if those wages are lost due to a compensable injury;
and
(F) Unemployment insurance
benefits paid to the injured employee during the twelve (12) months preceding
the month of injury will be taken into account when computing the actual
monthly earnings in cases where there are special circumstances under which the
actual monthly earnings cannot be determined.
(ii) The term "actual monthly earnings" does
not include:
(A) Severance pay;
(B) The cash value of health, medical, life
or other insurance benefits or retirement benefits;
(C) Social security benefits;
(D) Passive investment income such as income
from stocks, bonds, trust accounts, or individual retirement
accounts;
(E) Any adjustments to
the employee's income, as defined in paragraph (i) of this subsection, made
subsequent to the date of accident or incident causing the original injury;
and
(F) The amount reimbursed to an
employee for any special expense incurred by the employee by the nature of the
employment.
(e) Alcohol. Ethyl alcohol or other low
molecular weight alcohols, including methyl or isopropyl, from whatever source
or by whatever process produced.
(f) Alcohol Test means an analysis of breath
or saliva or any other analysis, which determines the presence and level or
absence of alcohol, as authorized by the United States Department of
Transportation in its rules and guidelines concerning alcohol testing and drug
testing.
(g) Certified Laboratory.
Any United States laboratory certified by the United States Department of
Health and Human Services (HHS) under the National Laboratory Certification
Program as meeting the minimum standards of Subpart C of the HHS Mandatory
Guidelines for Federal Workplace Drug Testing Programs.
(h) Chain of Custody. The methodology of
tracking specified materials or substances for the purpose of maintaining
control and accountability from initial collection to final disposition for all
such materials or substances, and providing for accountability at each stage in
handling testing, storing specimens, and reporting test results.
(i) Claim. An application for benefits under
the Act using the forms provided by the Division.
(j) Clerical Office Occupations. Employees
whose duties are confined to keeping the books and records of the business or
who are engaged wholly in office work. Employees shall have a physical
separation from exposure to the hazards associated with the business' normal
activities. Employees shall not have direct contact with, supervision of, or be
involved in physical labor of, the employer's operation, except, if incidental.
Employees who qualify may include employees who work with financial or employee
records, correspondence, or telephone duties. Employees qualifying for the
clerical office occupation classification who perform any duties outside of the
clerical office area or who perform duties which are not directly related to
the performance duties inside the clerical office, become disqualified for the
clerical office occupation classification for the reporting period when the
non-clerical work is performed. The limited exceptions allowed are solely for
the direct travel to and from a local post office, bank, office supply store or
the primary business location if travel is being compensated by the employer.
(i) Employers must request the clerical
coverage classification in writing on a form prescribed by the Division showing
the number of clerical positions needed and a detailed description of job
duties and responsibilities for the clerical coverage being requested. An
election under this subsection shall become effective the first day of the
calendar quarter following the calendar quarter in which the election is
made.
(ii) The Division may revoke
the clerical office occupation classification when sufficient cause is found
such as miscategorization of wages.
(k) Chiropractic Utilization Guidelines means
the Chiropractic Utilization Guidelines for the Care and Treatment of
Injured Workers (3/1/18), as policy for the
determination of compensability of appropriate and reasonable chiropractic
treatment in the provision of care for injured workers. This does not include
any later amendments or editions of the incorporated matter. These guidelines
are available upon request through the Division and may be obtained on-line at:
http://www.wyomingworkforce.org/_docs/providers/Chiropractic-Guidelines.pdf
(l) Collective Group of County Governments or
County Government Entities. County government employer means any employer
operating with a primary classification of "county government". Only one county
collective system may exist for workers' compensation reporting purposes under
W. S. §
27-14-109.
(m) Computation of Time.
(i) In computing any period of time
prescribed by the Act or these rules, except the seventy-two (72) hour period
prescribed in W. S. §
27-14-502 and Wyoming Uniform Rules for
Contested Case Practice and Procedure, Chapter 2, Section 12, the day of the
act, event, or default from which the designated period of time begins to run
shall not be included. The last day of the period so computed shall be
included, unless it is a Saturday, a Sunday, or legal holiday, or, when the act
to be done is the filing of a paper, a day on which weather or other conditions
have made agency offices inaccessible, in which event the period runs until the
end of the following day which is not one of the aforementioned days. When the
period of time prescribed or allowed is less than eleven (11) days,
intermediate Saturdays, Sundays, and legal holidays shall be excluded in the
computation. When the period of time prescribed or allowed is eleven (11) or
more days, intermediate Saturdays, Sundays, and legal holidays shall be
included in the computation. As used in this rule, "legal holiday" includes any
day officially recognized as a legal holiday in this state by designation of
the legislature or appointment as a holiday by the governor.
(ii) Whenever a party has the right or is
required to do some act within a prescribed period after service of a notice or
other paper upon the party, and the notice or paper is served upon the party by
mail or by delivery to the agency for service, three (3) days shall be added to
the prescribed period.
(n) Concurrent Review. Concurrent review is
performed while the injured worker is still an inpatient and services are being
rendered. The review can occur if there is a need to extend a current
hospitalization, during an emergency admission, or when a provider/facility
notifies the Division of an admission for a non-emergent procedure and a
preauthorization was not performed.
(o) Confirmation Test. A second analytical
procedure used to identify the presence of a specific drug, alcohol or
metabolite in a specimen. The confirmation test shall be different in
scientific principle from that of the initial test procedure. The confirmation
method shall be capable of providing requisite specificity, sensitivity, and
quantitative accuracy.
(p)
Corporate Officers, Members of Limited Liability Companies, Partners, and Sole
Proprietors.
(i) Elective coverage for
officers of a corporation, members of a limited liability company, partners or
sole proprietors under W. S. §
27-14-108(k) must be
requested in writing on a form provided by the Wyoming Workers' Compensation
Division ("Division").
(ii)
Corporations which elect to obtain coverage under the act must notify the
Division within 30 days of a change in corporate officers. The election of
corporate officers will transfer from the prior individual to the newly elected
officer in the same position.
(iii)
Corporate officers shall be clearly identified as such on all reports to the
Division.
(iv) Coverage will be
discontinued at the end of the month in which the position no longer exists or
the position becomes vacant. The Division must be notified in writing within 30
days of such changes.
(q) County government or county government
entities means any employer operating with a primary classification of county
government.
(r) Drug. Marijuana,
Cocaine, Amphetamine, Opiate, Phencyclidine (PCP), a metabolite of any of the
substances, or any other controlled substance subject to testing pursuant to
drug testing regulations adopted by the United States Department of
Transportation.
(s) Drug Test means
any chemical, biological, or physical instrumental analysis administered by a
certified laboratory for the purpose of determining the presence, or absence of
a drug or its metabolites pursuant to regulations governing drug or alcohol
testing adopted by the United States Department of Transportation.
(t) Elective Surgery. Elective Surgery is
surgery, which may be required in the process of recovery from an injury or
illness but need not be done as an emergency to preserve life, function or
health.
(u) Emergency Health Care
Services. Emergency health care services means health care services for a
medical condition manifesting itself by acute symptoms of sufficient severity
such that the absence of immediate medical attention could reasonably be
expected to place the injured worker's health in serious jeopardy.
(v) Expert Reviewer. Expert reviewer means a
physician competent to evaluate the specific clinical issues involved in the
medical treatment services and where these services are within the scope of the
physician's practice.
(w) Filing.
Except as otherwise provided in the Act or these rules and regulations, a
document shall be deemed to have been filed with the Division on the date it is
received by the Division in the manner prescribed by the Act or these rules and
regulations.
(x) Fiscal Year. A
12-month period of time used for State budgetary purposes which commences on
July 1 of each year and ends on June 30 in the following year.
(y) Fixed Base of Operations. See definition
for "Principal Place of Business" in subsection (nn) of this section.
(z) Gainful Employment. The individual having
returned to work at a wage of no less than minimum wage, for at least 20 hours
per week for a period of two consecutive months. W. S. §§
27-14-404(b) and
27-14-408(a)(ii).
(aa) Hearing Examiner or Officer. See Wyoming
Uniform Rules for Contested Case Practice and Procedure, Chapter 2, Section (e)
or refer to:
http://psc.state.wy.us/pscdocs/dwnload/OAH/All%20Chapters%20-%20Clean%20Copy.pdf
(bb) Inside Sales. (Automotive Vehicle Sales)
A position predominantly engaged in automotive vehicle sales at the premises of
the business. Positions with duties involving servicing equipment do not
qualify for coverage under the sales classification.
(i) Employers must request the inside sales
(automotive vehicle sales) classification in writing on a form provided by the
Division. An election under this subsection shall become effective the first
day of the calendar quarter following the calendar quarter in which the
election is made.
(ii) The Division
may revoke the inside sales occupation classification when sufficient cause is
found such as miscategorization of wages.
(cc) Intoxicated means pursuant to W. S.
§
27-14-102(a)(xi)(B)(I) a
positive alcohol test result at or above .08 alcohol concentration
level.
(dd) Maximum Medical
Improvement (MMI). A medical condition or state that is well stabilized and
unlikely to change substantially in the next year, with or without medical
treatment. Over time, there may be some change; however, further recovery or
deterioration is not anticipated. This term may be used interchangeably with
the term "ascertainable loss", defined in W. S. §
27-14-102(a)(ii).
(ee) Medical and Hospital Care. For purposes
of W. S. §
27-14-102(a)(xii), "personal
items" are defined as:
(i)
Clothing;
(ii) Footwear, unless
such items are professionally altered to accommodate the compensable
injury;
(iii) Hot tubs, spas or any
other devices wherein water is heated and/or circulated;
(iv) Programs, aids, medications or dietary
supplements primarily intended to help the worker stop smoking or lose
weight;
(v) Exercise
equipment;
(vi) Beds, mattresses or
mattress toppers; and
(vii)
Recliners or lift chairs.
(ff) Medical Service. Means any medical,
surgical, diagnostic, chiropractic, hospital, nursing care, ambulances,
prescription medicine, prosthetic appliances, and physical restorative
services.
(gg) Medically Necessary.
"Medically necessary treatment" means those health services for a compensable
injury that are reasonable and necessary for the diagnosis and cure or
significant relief of a condition consistent with any applicable treatment
parameter.
(hh) Mentally
Incompetent. For purposes of W. S. §
27-14-505, an individual is mentally
incompetent if, due to a medically diagnosed mental disorder, the individual
lacks the ability to comprehend that an injury is compensable and lacks the
ability to comprehend that certain statutory guidelines must be complied with
in order to receive benefits.
(ii)
Normal Activities of Day-to-Day Living (ADL). Routine activities that people
tend to do every day without needing assistance. There are six (6) basic ADLs:
eating, bathing, dressing, toileting, transferring (walking) and continence as
used in W. S. §
27-14-102(a)(xi)(G).
(jj) Other Related Expenses. As used in W.S.
§
27-14-403(e)(ii), "other
related expenses" means expenses related to a funeral, burial or cremation,
including a wake or reception, headstone or marker, transportation, and lodging
for the immediate family in those situations where a work-related injury
culminated in death.
(i) The surviving family
member or guardian, eligible to receive reimbursement for other related
expenses must submit a request for reimbursement on a form provided by the
Division and follow the procedure outlined in Chapter 7, Section 3(a)(iii) of
these Rules.
(A) The term "immediate family"
is defined as the spouse, child(ren), step-child(ren), grandchild(ren),
parent(s), step-parent(s), parent in-laws, grandparent(s), step grandparent(s),
grandparent in-law(s), sibling(s), step-sibling(s), half sibling(s), and
sibling in-law(s) of the deceased.
(kk) Outside Sales. A position with duties
predominantly engaged in sales or collections away from the premises of the
business. The position may include duties performed at the business premises
that are necessary to the position's outside sales duties. Positions with
duties involving servicing equipment or delivery of the employer's product do
not qualify for coverage under the outside sales classification.
(i) Employers must request the outside sales
classification in writing on a form provided by the Division. Duties for each
outside sales classification position must be clearly identified.
(ii) An election under this subsection shall
become effective the first day of the calendar quarter following the calendar
quarter in which the election is made.
(iii) The Division may revoke the outside
sales occupation classification when sufficient cause is found such as
miscategorization of wages.
(ll) Prescription Medication. A drug or
medication lawfully prescribed by a physician for an individual and taken in
accordance with the prescription.
(mm) Primary Treating Health Care Provider.
The health care provider selected by the employee to administer and direct
medical treatment for his/her compensable injury W. S. §
27-14-401(f).
(nn) Principal Place of Business. For
purposes of W. S. §
27-14-301(b) and W. S.
§
27-14-107(j), a "principal
place of business within the state established for legitimate business-related
purposes" must have the following characteristics:
(i) Exclusive use of fixed premises with a
recognizable physical address;
(ii)
A business sharing building or trailer space must have a clearly defined
location used exclusively for its business.
(iii) At least one employee who regularly
performs most of his services for the business in or based out of the fixed
premises;
(iv) Is accessible by
mail or other recognized delivery service; and
(v) Regularly conducts its primary business
or necessary ancillary services at the fixed premises.
(oo) Rating System:
(i) Base Rate. As used in these rules and
regulations, the term "base rate" means that percentage of total payroll
necessary to maintain an actuarially sound workers' compensation insurance
program. Each major industry classification shall have a separate base rate
based upon that industry's primary nature of business regardless of individual
occupations within that industry.
(ii) Experience Rating. As used in these
rules and regulations, the term "experience rating" means that percentage
increase or decrease which is applied to the base rate of an employer account.
The experience rating is based upon frequency and severity of injuries reported
to the Division.
(iii) Consolidated
Accounts. Employers electing a consolidated account as provided in W. S. §
27-14-202(d) shall report
each worker within the classification for which the worker performs the largest
percentage of services.
(iv)
Presumed Pay of Specified Workers. Deemed income for those categories of
workers identified in W. S. §
27-14-205(b) shall be
calculated by determining the amount of premium income necessary to pay
actuarially anticipated losses in each category during the rating period, and
considering the anticipated number of covered workers and the appropriate
premium rate for each category.
(v)
Pursuant to W. S. §
27-14-102(K), a collective
group of county governments is defined as all county government employers
consolidating into one workers' compensation account in order to operate as
defined under W. S. §
27-14-109.
(pp) Reasonable Period of Recuperation. As
used in W. S. §
27-14-404(b), a "reasonable
period of recuperation" includes the day of surgery and the period of
recuperation for the surgery performed.
(qq) Rehabilitation Therapy Utilization
Guidelines. Means the May 2015 edition of the of the Rehabilitation
Therapy Utilization Guidelines for the Care and Treatment of Injured
Workers, as policy for the determination of compensability of
appropriate and reasonable physical, occupational and speech therapy treatment
in the provision of care for injured workers. These guidelines are available
upon request through the Division and may be obtained on-line at:
http://www.wyomingworkforce.org/providers/
(rr) Remuneration. Except as provided in W.
S. §
27-14-102(a)(ix), if board,
lodging or any other payment in kind, considered as payment for services
performed by a worker, is in addition to or in lieu of a monetary wage, the
Division shall determine or approve the cash value of such payment in kind, and
the employer shall use these cash values in computing the employee's wages and
contributions due under the law. Remuneration shall not include per diem
payments, if the employer maintains an "Accountable Plan" as required in
Chapter 2, Section 14 of these rules.
(ss) Specimen means tissue, fluid, or a
product of the human body capable of revealing the presence of alcohol, drugs
or their metabolites.
(tt) Suitable
Employment. Employment for which the worker has the necessary physical
capacities, knowledge, transferable skills and abilities. W. S. §
27-14405(h)(iii).
(uu) Under the
Influence of a Controlled Substance means pursuant to W. S. §
27-14-102(a)(xi)(B)(I) a
positive drug test conducted in accordance with the U.S. DOT drug and alcohol
testing regulations from an HHS-certified laboratory.
(vv) United States Territories. United States
territories include: American Samoa, Bajo Nuevo Bank, Baker Island, Howland
Island, Guam, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Islands,
Navassa Island, Northern Mariana Islands, Puerto Rico, Serranilla Bank, U.S.
Virgin Islands and Wake Island, W. S. §
27-14-301(a)(ii).
(ww) University of Wyoming:
(i) UW Professionals with Lab. Professional
faculty, administrators, and support personnel of institutions of learning
whose duties include performing in a scientific laboratory
environment.
(ii) UW Professional
without Lab. Professional faculty, administrators, and support personnel of
institutions of learning whose duties do not include performance in a
scientific laboratory environment.
(iii) UW Clerical. Support staff of
institutions of learning who typically work in an office environment, whose
duties do not include performing in a scientific laboratory
environment.
(iv) UW
Non-Professional. Positions not defined in (i), (ii) or (iii) of this
subsection.
(xx) Usual
and Customary. The provider's charge to the general public for the same or
similar service.
Notes
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