Workers’ Compensation Definitions
Answers For Injured Workers In California
The workers’ compensation laws in California have become more and more complex in just the past couple of years. To help you understand some basic workers’ compensation concepts, below are some very useful definitions of terms that will affect your work injury case.
Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. If you don’t have an attorney, you will use a qualified medical evaluator (QME).
AOE/COE (Arising out of and occurring in the course of employment): Your injury must be caused by and happen on the job.
Applicant: The injured worker.
Application for adjudication of claim: A form you file to open a case at the Workers’ Compensation Appeals Board (WCAB).
Apportionment: A way of figuring out how much of your permanent disability is due to your work injury and how much is due to other disabilities.
Benefit notice: A required letter or form sent to you by the insurance company to inform you of benefits you may be entitled to receive.
California Labor Code section 132a: A workers’ compensation law that prohibits discrimination against you because you filed a workers’ compensation claim.
Claim form: The form used to report a work injury or illness to your employer. It is also known as a DWC 1 form.
Compromise and release (C&R): A type of settlement in which you receive a lump-sum payment based on the percentage of permanent disability you have and you become responsible for paying for your future medical care, instead of the insurance company. A C&R must be approved by a workers’ compensation judge.
Cumulative injury (CT): An injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over.
Declaration of readiness (DOR or DR): A form used to request a hearing before a workers’ compensation judge in order to resolve a dispute.
Delay letter: A letter sent to you by the insurance company that explains why payments are delayed. The letter also tells you what information is needed before payments will be sent and when a decision will be made about the payments.
Denied claim: A claim in which the insurance company believes your injury or illness is not covered by workers’ compensation.
Disability Evaluation Unit (DEU): A unit within the DWC that calculates the percent of permanent disability based on medical reports.
Findings & award (F&A): A written decision by a workers’ compensation judge about your case, including payments and future care that must be provided to you. The F&A becomes a final order unless appealed.
Work comp fraud: Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers’ compensation benefits. The penalties for committing fraud are fines up to $150,000 and/or imprisonment for up to five years.
Future medical: Ongoing right to medical treatment for a work-related injury.
In pro per: An injured worker not represented by an attorney.
Information & assistance unit (I&A): An office within the Division of Workers’ Compensation that provides information to injured workers in workers’ compensation claims.
Impairment rating: A percentage estimate of how much normal use of your injured body parts you’ve lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA).
Mandatory settlement conference (MSC): A required conference to discuss settlement prior to a trial.
Maximal medical improvement (MMI): A doctor has determined that your injury is unlikely to change substantially in the next year, with or without medical treatment. Once you reach MMI, a doctor can assess how much, if any, permanent disability resulted from your work injury.
Medical provider network (MPN): A group of health care providers approved by the DWC’s administrative director to treat workers injured on the job, from which the injured worker selects a primary treating physician.
Modified work: Going back and working your old job, with some restrictions that allow you to do it.
Panel qualified medical evaluator (QME): A list of three independent qualified medical evaluators (QMEs) issued by the DWC Medical Unit. You select any one of the three doctors for your evaluation. If you have an attorney, other rules apply.
Permanent and stationary (P&S): Your medical condition has reached maximum medical improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted from your work injury.
Permanent disability (PD): Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached.
Permanent disability benefits: Payments you receive when a doctor determines that you have a permanent disability.
Primary treating physician (PTP): The doctor having overall responsibility for treatment of your work injury or illness. This physician writes medical reports that may affect your benefits. Also called treating physician or treating doctor.
Qualified medical evaluator (QME): An independent physician certified by the DWC Medical Unit to perform medical evaluations.
Specific injury: An injury caused by one event at work, as opposed to a cumulative trauma (an injury that happens over time from repetitive work).
Stipulations with request for award (Stips): A settlement in which the parties agree on the terms of an award. It may include future medical treatment. Payment takes place over time. This document is presented to the judge for final approval.
Supplemental job displacement benefit (SJDB): If you have a permanent partial disability that prevents you from doing your old job, and your employer does not offer other work, you qualify for this benefit. It is in the form of a voucher that promises to help pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools. It is also called SJDB voucher.
Temporary partial disability (TPD) benefits: Payments you get if you can do some work while recovering, but you earn less than before the injury.
Utilization review (UR): The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.
Workers’ Compensation Appeals Board (WCAB): This is the court for injured workers where disagreements over workers’ compensation benefits are heard by workers’ compensation judges.
Work restrictions: A doctor’s description of the work you can and cannot do. Work restrictions are designed to help protect you from further injury.