053-1 Wyo. Code R. § 1-3

Current through April 27, 2019

Section 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 where such books and records are kept. 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, or office supply store.

• (i) Employers must request the clerical coverage classification in writing on a form prescribed by the Division showing the name and a detailed description of job duties and responsibilities for each worker for whom clerical coverage is 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 case 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, durable medical equipment, 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.

053-1 Wyo. Code R. § 1-3

Amended, Eff. 8/24/2017.

Amended, Eff. 11/13/2018.