Rule 49: Definitions

The following words and terms, when used in the Rules of Procedure of the Nebraska Workers’ Compensation Court shall have the following meanings, unless the context of the particular rule clearly indicates otherwise.

A. Compensability. “Compensability” or “compensable” when used with reference to injuries or diseases means personal injuries for which an employee is entitled to compensation from his or her employer pursuant to section 48-101.

B. Complex Case. “Complex case” when used with reference to fees for services performed by an independent medical examiner means a case requiring two or more of the following in order to render medical findings on the questions and issues submitted:

1. two or more hours of face-to-face time by the physician with the patient;

2. two or more hours of record review by the physician;

3. two or more hours of medical research by the physician;

4. addressing the issue of medical causation;

5. addressing the issue of apportionment between any preexisting impairment or disability and the impairment or disability contributed by the injury in question.

C. Denial of Compensability. “Denial of compensability” or “compensability is denied” means a denial that the employee is entitled to compensation for personal injury from his or her employer pursuant to section 48-101.

D. Emergency Medical Treatment. “Emergency medical treatment” means those medical services that are required for the immediate diagnosis and treatment of conditions that, if not immediately diagnosed and treated, could lead to serious physical or mental disability or death, or that are immediately necessary to alleviate severe pain. “Emergency medical treatment” includes treatment delivered in response to symptoms that may or may not represent an actual emergency, but is necessary to determine whether an emergency exists.

E. Family Physician. “Family physician” when used with reference to an employee’s right to choose a primary treating physician, means a physician who has maintained the medical records of and has a documented history of treatment with the employee or an employee’s immediate family member prior to an injury.

F. Health Care Providers. “Health care providers” means providers or suppliers of health care services.

G. Health Care Services. “Health care services” means medical, surgical, or hospital services, including specialized medical services, for which the employer is liable pursuant to section 48-120.

H. Immediate Family Member. “Immediate family member” when used with reference to the selection of a physician pursuant to section 48-120(2)(a) means the employee’s spouse, children, parents, stepchildren, and stepparents.

I. Independent Medical Examiner. “Independent Medical Examiner” means either a physician appointed and assigned by the court or a physician agreed to by the parties pursuant to section 48-134.01. In either case the physician shall render medical findings on the medical condition of an employee and related issues pursuant to section 48-134.01.

J. Major Surgical Operation. “Major surgical operation” means any invasive procedure that requires the penetration of the body or removal of human tissues and requires the administration in any concentration of anesthesia or sedation which renders an individual incapable of taking action for self-preservation under emergency conditions without the assistance of another individual.

K. Managed Care Plan. “Managed care plan” means a plan certified by the court that provides for the delivery and management of treatment to injured employees.

L. Nonparticipating Physician. “Nonparticipating Physician” when used with reference to a managed care plan means a physician who is not a participating physician, but who may provide services pursuant to Rule 56 to an employee subject to a managed care plan contract.

M. Participating Physician. “Participating Physician” means a physician with which a managed care plan has a contract or other arrangement for the delivery of health care services to injured employees.

N. Participating Health Care Provider. “Participating health care provider” means any person or entity with which the managed care plan has a contract or other arrangement for the delivery of health care services to injured employees.

O. Physician. “Physician” means any person licensed to practice medicine and surgery, osteopathic medicine, chiropractic, podiatry, or dentistry in the State of Nebraska or in the state in which the physician is practicing.

P. Primary Treating Physician. “Primary treating physician” means a physician who is responsible for providing primary medical care to the employee, maintaining the continuity of the employee’s medical care and initiating referrals to other health care providers.

Q. Probation. “Probation” or “probationary status” when used with reference to vocational rehabilitation means the limitation for a specified period of time and under such conditions as determined by the court of a vocational rehabilitation provider’s certification to provide vocational rehabilitation services under Rules 37 through 44, or to perform a loss of earning power evaluation under Rule 45.

R. Revocation. “Revocation” or “revoked” when used with reference to vocational rehabilitation means the termination, prior to the normal expiration date, of a vocational rehabilitation provider’s certification to provide vocational rehabilitation services under Rules 37 through 44, or to perform a loss of earning power evaluation under Rule 45. “Revocation” or “revoked” when used with reference to a managed care plan means the termination of a managed care plan’s certification to provide services under Rules 51 through 61.

S. Specialized Medical Services. “Specialized medical services” means healthcare services other than those provided by a primary treating physician.

T. Suspension. “Suspension” or “suspended” when used with reference to a managed care plan means that a managed care plan’s authority to enter into new or amended contracts with insurers, risk management pools, or self-insured employers has been suspended by the court for a period of time.