Workers’ Compensation Terminology
For over a decade the lawyers of Canlas Law Group, have been helping injured workers receive the workers’ compensation medical care and pay benefits they need and deserve.
One thing never changes: The terminology is confusing and the process is always frustrating. Our attorneys represent clients in Los Angeles County, Orange County, San Bernardino County and those located all throughout Southern California.
Here is a brief list of some of the most common terms and workers’ compensation definitions:
- Agreed Medical Examiner (AME): A physician selected by your attorney and the claims administrator who conducts a medical evaluation and submits a comprehensive report to the parties.
- AOE/COE (Arising out of and occurring in the course of employment):
This means that an industrial injury must be caused by and happen on the job.
- Applicant: The party, usually the injured worker, who establishes a case before the Workers’ Compensation Appeals Board (WCAB).
- Application for Adjudication of Claim (Application or App): Filing this form establishes a case before the Workers’ Compensation Appeals Board (WCAB). A WCAB case number will be assigned.
- Apportionment: A way of figuring out how much of your permanent disability is due to your industrial injury and how much is due to other disabilities.
- Audit Unit: A unit within DWC that receives complaints against claims administrators. These complaints may lead to an investigation or audit of the company’s claims handling practices.
- Claim Form: A form to report a work injury or illness to your employer.
- Claims Administrator: This is the term for insurance companies and others who handle your workers’ compensation claim.
- Commutation: An order by a Workers’ Compensation Administrative Law Judge for a lump sum payment of part or all of your permanent disability award. Payment can be made to either the injured worker or the injured worker’s attorney. This order can only be requested after you have either settled your case with a Stipulation with Request for Award or received a Findings and Award.
- Compromise and Release (C&R): Generally, a final settlement of your workers’ compensation case where the parties agree on a single lump sum payment. It usually settles all outstanding issues except for future vocational rehabilitation.
- Consultative Rating: A rating of permanent disability provided by the DWC Disability Evaluation Unit when a claim is litigated or if the injured worker has an attorney. See Permanent Disability Rating.
- Cumulative Trauma (CT): An injury or illness that occurs over a period of time. For example, Carpal Tunnel Syndrome.
- Death Benefits: Benefits paid to surviving dependents if a work related injury or illness results in death within five years.
- Declaration of Readiness (DOR or DR): A form to request a hearing before a Workers’ Compensation Administrative Law Judge in order to resolve a dispute.
- Defendant: The employer or his/her representative, usually the insurance company.
- Deposition: A formal session in which an attorney asks questions of a party under oath. It is the equivalent of testifying at a trial. The testimony is recorded by a court reporter and may be used as evidence in a trial situation. Depositions may only take place if an Application for Adjudication has been filed.
- Disability Evaluation Unit (DEU): A unit within DWC that calculates the percent of permanent disability based upon the medical reports.
- Discrimination Claims (Labor Code 132a): A petition filed because your employer has discharged you or otherwise discriminated against you because of your industrial injury.
- Division of Workers’ Compensation (DWC): The state agency that oversees the California workers’ compensation system.
- Findings & Award (F&A): A Workers’ Compensation Administrative Law Judge’s decision finding that an applicant is entitled to disability benefit payments, future medical treatment, or both.
- Findings & Order (F&O): A Workers’ Compensation Administrative Law Judge’s decision in which no disability payments or future medical treatment is awarded.
- First Aid: Any one-time treatment, and any follow-up visit for the purpose of observation, of minor scratches, cuts, burns, splinters, etc. which do not ordinarily require medical care. The one-time treatment and follow-up visit for observation may be provided by a physician or registered professional personnel.
- Fraud: Any knowingly false or fraudulent material statement for the purpose of obtaining or denying workers’ compensation benefits.
- Future Medical: On-going entitlement to medical treatment for a work related injury.
- Hearings: Formal proceedings held at the Workers’ Compensation Appeals Board (WCAB) before a Workers’ Compensation Administrative Law Judge.
- Independent Medical Review (IMR): The process to resolve disputes regarding the medical treatment of injured employees.
- Industrial Medical Council (IMC): The state agency that certifies Qualified Medical Evaluators (QME) and issues Panel QMEs when there is a dispute with the treating doctor’s report. (see Panel QME.)
- Lien: A right or claim for payment against a workers’ compensation case.
- Light Duty: Temporary change in job assignment to accommodate work restrictions while you are healing. May or may not pay at the same rate as your normal work assignment. Lost wages may be partially made up by Temporary Partial Disability (TPD) payments.
- Litigated Claim: A workers’ compensation claim where an Application for Adjudication has been filed.
- Mandatory Settlement Conference (MSC): A required conference to discuss settlement of disputed issues prior to a trial.
- Medical Treatment: Treatment reasonably required to cure or relieve from the effects of a work-related injury or illness.
- Modified Work: A change in your working conditions in order to accommodate permanent work restrictions determined by your Primary Treating Physician when you have become Permanent and Stationary.
- Panel Qualified Medical Evaluator: A list of three independent qualified medical evaluators issued by the state Industrial Medical Council.
- Party: Normally this includes you, the claims administrator, your employer, attorneys, and any other person who has an interest in your claim (for example, doctors or hospitals that have not been paid).
- Permanent and Stationary (P&S): A term for describing when your medical condition has reached maximum medical improvement.
- Permanent Disability (PD): Any residual disability that impairs your ability to compete in the open labor market after you become permanent and stationary.
- Permanent Disability Advance (PDA): A voluntary lump sum payment on permanent disability due in the future.
- Permanent Disability Payments: Mandatory bi-weekly payments on the undisputed portion of permanent disability, prior to or subsequent to an award.
- Permanent Disability Rating: The determination of your level of permanent disability based on a physician’s medical report. Ratings can be done by claims administrators, attorneys, independent raters or the Disability Evaluation Unit.
- Petition for Reconsideration (Recon): An appeal of a decision issued by a Workers’ Compensation Administrative Law Judge. It must be filed within 20 days of the judge’s final decision.
- Pre-designated Physician: A Primary Treating Physician that can initially treat you if you have advised your employer in writing prior to the industrial injury or illness. You must have seen the predestinated physician prior to selection.
- Primary Treating Physician (PTP): The doctor who has overall responsibility for treatment of your industrial injury or illness. There can only be one PTP at a time.
- Qualified Medical Evaluator (QME): An independent physician certified by the Industrial Medical Council to perform medical evaluations.
- Serious and Willful Misconduct (S&W): A petition filed if the injury is caused by the serious and willful misconduct of the employer or the injured worker.
- Settlement: A workers’ compensation cases may be settled in one of two ways, by a Compromise and Release (C&R) or by a Stipulation with Request for Award (Stip). A C&R usually settles all outstanding issues in a claim for a single lump sum payment. A Stipulation may leave certain issues open, such as future medical treatment and/or vocational rehabilitation.
- State Disability Insurance (SDI): A branch of the Employment Development Department that pays temporary disability benefits for non-industrial injuries or illnesses.
- Stipulation with Request for Award (Stip): A settlement where the parties agree on the terms of an award. It may include any future medical treatment. Payment takes place over time.
- Temporary Disability (TD) or Temporary Total Disability (TTD): A wage replacement benefit paid when your physician reports you cannot work because of an industrial injury or illness.
- Temporary Partial Disability (TPD): A wage replacement benefit that may be paid when you return to work but at less than full earnings. Sometimes referred to as Wage Loss.
- Transportation Expenses: A benefit to cover your out-of-pocket expenses for mileage, parking, and toll fees related to a claim, usually a reimbursement.
- Uninsured Employers Fund (UEF): If your employer is illegally uninsured, this fund may provide benefits to you.
- Utilization Review: The process where the insurance company reviews requested medical treatment from the treating doctors and determines whether they consider the treatment medically reasonable or necessary.
- Supplemental Job Displacement Benefits: (formerly called “vocational rehabilitation retraining”) comes in the form of a voucher and can be used by workers to pay for the costs of school or training in order to gain the skills they need to enter new lines of work. The voucher can be used for a variety of educational and job training expenses, including school tuition and fees, books and other materials, and career counseling. Depending on the date of the work injury, the value of this benefit is between $4,000 to $10,000.
- Wage Loss: Temporary disability benefits that may be paid when an employee returns to work at less than full earnings. Also known as Temporary Partial Disability (TPD).
- Workers’ Compensation Appeals Board (WCAB): The judicial unit that formally resolves workers’ compensation disputes.
- Workers’ Compensation Administrative Law Judge: Judges at DWC district offices that conduct hearings, take evidence, issue decisions, and approve settlements.
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This is just a comprehensive list of some of the most common terms you will hear during the workers’ compensation process.