CMP.6.2.010 Definitions

(a) Accident

An event that is sudden, unexpected and unforeseen by the injured person.

(b) Claim

A written request for Worker's Compensation benefits under this Ordinance.

(c) Claims Administrator/Managed Care Provider

"Claims Administrator/Managed Care Provider", with whom the Employer has contracted with to act on behalf of the Employer for compliance with this Ordinance and to evaluate Worker's Compensation claims.

(d) Compensable Injury

A bodily illness or accident to an Employee while performing the specified duties and services associated with employment in or on the premises of the Employer. Injuries due to repetitive or cumulative trauma may be deemed compensable if the condition is determined to be solely related to the employment and the Employee has no prior treatment history of a pre-existing condition.

(e) Disability

The actual incapacity to perform the tasks usually encountered in the Employee's employment and the wage loss resulting there from, or physical impairment of the body that may or may not be incapacitating.

(f) Employee

An individual hired by the Employer who performs specified duties and services at an established wage or salary. An employee of Lac Courte Oreilles Tribal Government and Enterprises is covered, whether they are employed full-time, part-time, temporarily or seasonally. Employees are covered while in the course and scope of employment for Lac Courte Oreilles Tribal Government and Enterprises, whether on or off the reservation. Employee includes persons who are serving community service, fire department volunteers, first responders, assigned from the county jail Huber program and summer youth workers. If there is a question as to whether or not you are covered, check with your Director/Supervisor/Manager.

(g) Employer

The Lac Courte Oreilles Tribal Government and Enterprises

(h) Insurance Appeal Board

An appeal board consisting of five individuals appointed by the Tribal Governing Board who will hear an appeal filed by an Employee in accordance with Section CMP.6.6.020. The Board shall be comprised of one medical professional, a human resources representative, the employee's immediate supervisor and two members of the Lac Courte Oreilles Insurance Task Force.

(i) MMI

Maximum Medical Improvement means the date after which no further significant lasting improvement to a personal injury can reasonably be anticipated.

(j) Occupation Disease

A harm that results from occupational exposure but is not so sudden or traumatic as to fit within the definition of an accident. It includes systemic infections and exposure to toxins/poison fumes in the work environment usually over a long period of time.

(k) Plan Administrator

"Plan Administrator" means the person appointed by the Lac Courte Oreilles Tribal Governing Board, who will serve at the direction of the Employer to administer this Ordinance in accordance with its terms. Also referred to as the Employer's Insurance Officer.

(l) Premises

The specific geographic area within which the Employee fulfills the Employee's duties and responsibilities to the Employer in the normal course of employment.

(m) Rehabilitations

Vocational Rehabilitation is a tool used to assist the employee in returning to work.

(n) The Plan

The Lac Courte Oreilles Tribal Government Workers' Compensation Ordinance.

(o) Weekly Wage

Weekly wage is arrived at by multiplying the daily wage by the number of days or fraction of days normally worked