R612-100-2. Definitions

  A. "Administrative Law Judge" or "ALJ" means a person designated by the Commission to hear and decide disputed cases.

  B. "Claimant" means an injured employee, dependent(s)of an injured employee, medical providers, or any other person seeking relief or claiming benefits under the Utah Workers' Compensation Act or Utah Occupational Disease Act.

  C. "Award" means a determination of the Commission, Appeals Board or Administrative Law Judge of the benefits due a claimant.

  D. "Benefits" includes any payment, entitlement, or other relief provided under the Utah Workers' Compensation Act or Utah Occupational Disease Act.

  E. "Commission" means the Utah Labor Commission.

  F. "Defendant" means an employer, insurance carrier, Employers' Reinsurance Fund, Uninsured Employers' Fund or other person or entity against whom a claim for benefits is made.

  G. "Division" means the Division of Industrial Accidents within the Commission.

  H. "Disabled Injured Worker" means an injured worker who:

  1. because of the injury or disease that is the basis for the employee being an injured worker:

  a. is or will be unable to return to work in the injured worker's usual and customary occupation; or

  b. is unable to perform work for which the injured worker has previous training and experience; and

  2. reasonably can be expected to attain gainful employment after an evaluation provided for in accordance with Section 34A-2-413.5.

  I. "Employer" is defined in Section 34A-2-103 of the Utah Workers Compensation Act and includes self-insured employers and uninsured employers.

  J. "First Aid" is medical care that is:

  1. administered on-site or at an employer-sponsored free clinic; and

  2. limited to the following:

  a. non-prescription medications at non-prescription strength:

  b. tetanus immunizations;

  c. cleaning and applying bandages to skin surface wounds;

  d. hot or cold packs, contrast baths and paraffin;

  e. non-rigid support, such as elastic bandages, wraps, and back belts;

  f. temporary immobilization devices for transporting an accident victim, such as splints, slings, neck collars, or back boards;

  g. drilling a fingernail or toenail to relieve pressure, or draining fluids from blisters;

  h. eye patches or use of simple irrigation or a cotton swab to remove foreign bodies not embedded in or adhering to an eye;

  i. use of irrigation, tweezers, or cotton swab to remove splinters or foreign material;

  j. finger guards;

  k. massages;

  l. drinking fluids to relieve heat stress.

  3. "First aid" is limited to initial treatment and one follow-up visit within a seven-day period after the initial treatment, except that if first aid treatment was provided by a licensed health professional in an employer-sponsored free clinic, first aid includes initial treatment and two follow-up visits within a fourteen-day period after the initial treatment.

  4. "First aid" does not include any treatment of a work injury that results in:

  a. loss of consciousness;

  b. loss of work;

  c. restriction of work;

  d. transfer to another job.

  K. "Injury" includes work-related accidental injury and occupational disease.

  L. "Insurance Carrier" includes any worker's compensation insurance carriers, self-insured employer and self-insured employer's adjusting company, unless otherwise specified.

  M. "Payor" means any insurance carrier, self-insured employer, or uninsured employer that is liable for any benefit or other relief under the Utah Workers' Compensation Act or Utah Occupational Disease Act.

  N. "Usual and Customary Rate (UCR)" is the rate of payment using Ingenix, or a similar service, for charges for services in a particular zip code.