Division of Workers' Compensation fact sheet B
Glossary of workers’ compensation terms for injured workers
workers’ compensation. Even if your claim is accepted there may be delays or other problems. Also called
Workers’ Compensation (DWC) adopts medical treatment guidelines, the guidelines published by ACOEM,
called “Occupational Medicine Practice Guidelines,” are the guidelines used in most cases to decide the
type and amount of treatment you’ll receive for a work injury or illness.
Agreed medical evaluator (AME):
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). See QME.
return to your job at the time of injury, your employer is encouraged to offer you alternative work instead
of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must
meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits
you were paid at the time you were injured, and be within a reasonable commuting distance of where you
lived at the time of injury.
American Medical Association (AMA):
guidelines called “Guides to the Evaluation of Permanent Impairment.” If your permanent disability is
rated under the 2005 rating schedule, the doctor is required to determine your level of impairment using
the AMA’s guides.
Americans with Disabilities Act (ADA):
disabilities. If you believe you’ve been discriminated against at work because you’re disabled and want
information on your rights under the ADA, contact a U.S. Equal Employment Opportunity Commission
office. For the EEOC office in your area, call 1-800-669-4000 or 1-800-669-6820 (TTY).
AOE/COE (Arising out of and occurring in the course of employment):
by and happen on the job.
Board (WCAB) office by filing an application for adjudication of claim
decisions of workers’ compensation administrative law judges. Also called the Reconsideration Unit. See
Workers’ Compensation Appeals Board
refers to you, the injured worker.
Application for adjudication of claim (application or app):
local Workers’ Compensation Appeals Board (WCAB) office if you have a disagreement with the insurance
company about your claim.
and how much is due to other disabilities.
complaints may lead to investigations of the way the company handles claims.
benefits you may be entitled to receive. Also called notice.
inspects workplaces and enforces laws to protect the health and safety of workers in California.
California Labor Code section 132a:
you because you filed a workers’ compensation claim, and against co-workers who might testify in your
compensation benefit delivery and dispute resolution under a collective bargaining agreement.
compensation claim. Most claims administrators work for insurance companies or third party
administrators handling claims for employers. Some claims administrators work directly for large
employers that handle their own claims. Also called claims examiner or claims adjuster.
Commission on Health and Safety and Workers’ Compensation (CHSWC):
that conducts studies and makes recommendations to improve the California workers’ compensation and
workplace health and safety systems.
permanent disability award.
Compromise and release (C&R):
become responsible for paying for your future medical care. A settlement like this must be approved by a
workers’ compensation judge.
Cumulative injury (CT):
For example, hurting your wrist doing the same motion over and over or losing your hearing because of
constant loud noise.
Date of injury:
the date of injury. If the injury or illness was caused by repeated exposures (a cumulative injury), the
date of injury is the date you knew or should have known the injury was caused by work.
Declaration of readiness (DOR or DR):
compensation judge when you’re ready to resolve a dispute.
over benefits or services.
The letter also tells you what information is needed before payments will be sent and when a decision will
be made about the payments.
workers’ compensation and has notified you of the decision.
Description of employee’s job duties (RU-91):
company that helps your treating physician decide whether you will be able to return to your normal job
and working conditions.
Determination and order (D&O):
engaging in physical, social and work activities difficult.
Disability Evaluation Unit (DEU):
disability based on medical reports. See disability rater.
the start of a disability, to encourage and support continued employment. This is done early in the
recovery process in severe injury cases such as spinal injuries. Usually a rehabilitation nurse is involved
with you and your treating doctor and the progress of your medical treatment is reported to the insurance
after reviewing a medical report or a medical-legal report describing your condition.
Discrimination claim (Labor Code132a):
discriminated against you for filing a workers’ compensation claim.
Division of Workers’ Compensation (DWC):
Relations (DIR). The DWC administers workers' compensation laws, resolves disputes over workers'
compensation benefits and provides information and assistance to injured workers and others about the
workers’ compensation system.
employee includes undocumented workers and minors.
the employees who perform the work. That means considering the variability in human capabilities when
selecting, designing or modifying equipment, tools, work tasks and the work environment.
considered for alternative work, you must have both the physical and mental qualifications to fulfill
the job’s essential functions.
Fair Employment and Housing Act (FEHA):
with disabilities. If you believe you’ve been discriminated against at work because you’re disabled and
want more information on your rights under the FEHA, contact the state Department of Fair Employment
and Housing at 1-800-884-1684. In some cases, the FEHA provides more protection than the federal
Americans with Disabilities Act (ADA).
Family and Medical Leave Act (FMLA):
health problems or who need to care for a child or other family member with up to 12 weeks of unpaid,
job-protected leave per year. It also requires that group health benefits be maintained during the leave.
For more information, contact the U.S. Department of Labor at 1-866-4-USA-DOL.
process. The date of filing is the date the document is received.
appealed in a timely way.
Findings & award (F&A):
about your case, including payments and future care that must be provided to you. The F&A becomes a
final order unless appealed.
compensation benefits. The penalties for committing fraud are fines up to $150,000 and/or imprisonment
for up to five years.
Health care organization (HCO):
provide managed medical care within the workers’ compensation system.
receives information in order to make a decision about a dispute or a proposed settlement.
In pro per:
the courts look at several factors when deciding if someone is an employee or an independent contractor.
Some employers misclassify employees as an independent contractor to avoid workers’ compensation and
other payroll responsibilities. Just because an employer says you are an independent contractor and
doesn’t need to cover you under a workers’ compensation policy doesn’t make it true. A true independent
contractor has control over how their work is done. You probably are not an independent contractor when
the person paying you:
Industrial Medical Council (IMC):
Information & Assistance Unit (I&A):
workers’ compensation claims and informally resolves disputes.
Information & Assistance (I&A) officer:
workers, provides written materials, conducts informational workshops and holds meetings to informally
resolve problems with claims.
Injury and illness prevention program (IIPP):
to develop and implement. This program is enforced by Cal/OSHA.
lost. Impairment ratings are determined based on guidelines published by the American Medical
Association (AMA). An impairment rating is used to calculate your permanent disability rating but is
different from your permanent disability rating.
medical provider, can file a form with the local Workers’ Compensation Appeals Board to request payment
of money owed in a workers’ compensation case.
Mandatory settlement conference (MSC):
Maximal medical improvement (MMI):
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.
not represented by an attorney.
are written to help clarify disputed medical issues.
Medical provider network (MPN):
self-insured employer and approved by DWC's administrative director to treat workers injured on the job.
or illness. Also called medical care.
medical review (IMR) physicians, health care organizations (HCOs), qualified medical evaluators (QMEs),
panel QMEs, utilization review (UR) plans, and spinal surgery second opinion physicians. Formerly called
the Industrial Medical Council (IMC).
be able to return to your job at the time of injury, your employer is encouraged to offer you modified work
instead of supplemental job displacement benefits or vocational rehabilitation benefits.
completed by both you and the insurance company. This is the document used to provide payment
for education under the supplemental job displacement benefit program.
AME says contribute to your permanent disability.
Off calendar (OTOC):
Offer of modified or alternative work form (RU-94):
you were injured before 2004 and; your treating physician says you probably will never return to your job
or one like it and; your employer is offering modified or alternative work instead of vocational
Offer of modified or alternative work (DWC form #AD 10133.53):
insurance company if: you were injured in 2004 or later and; your treating physician reports you have a
permanent disability and; your employer is offering modified or alternative work instead of a supplemental
job displacement benefit. This form also explains how your permanent disability payments may be lowered
by 15 percent because your employer is returning you to work.
Panel qualified medical evaluator (QME):
(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.
with an interest in your claim (doctors or hospitals that have not been paid).
Permanent and stationary (P&S):
improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted
from your work injury. If your disability is rated under the 2005 schedule you will see the term maximal
medical improvement (MMI) used in place of P&S. See also P&S report.
Permanent disability (PD):
maximum medical improvement is reached.
Permanent disability rating (PDR):
limits the kinds of work you can do. It is based on your medical condition, date of injury, age when
injured, occupation when injured, how much of the disability is caused by your job, and your diminished
future earning capacity. It determines the number of weeks you are entitled to permanent disability
Permanent disability rating schedule (PDRS):
used to rate permanent disabilities. One of three schedules will be used to rate your disability, depending
on when you were injured.
Permanent disability (PD) benefits:
the kinds of work you can do or your ability to earn a living.
Permanent disability advance (PDA):
due in the future.
Permanent disability payments:
permanent disability received before and/or after an award is issued.
Permanent partial disability award:
compensation judge or the Workers’ Compensation Appeals Board.
Permanent partial disability (PPD) benefits:
limits the kinds of work you can do or your ability to earn a living.
Permanent total disability (PTD) benefits
permanently unable to earn a living.
by your employer or the insurance company, the penalty amount can be an automatic 10 percent for a
delay in one payment to you, or a 25 percent penalty -- up to $10,000 -- for an unreasonable delay.
degree (osteopath), who has treated you in the past and has your medical records.
Petition for reconsideration (Recon):
compensation judge. Heard by the Workers' Compensation Appeals Board Reconsideration Unit, a sevenmember,
judicial body appointed by the governor and confirmed by the Senate.
podiatrist or a chiropractor licensed in California. The definition of personal physician is more limited. See
writing prior to your work injury or illness and certain conditions are met. See pre-designation.
you for a work injury. You can pre-designate your personal doctor of medicine (M.D.) or doctor of
osteopathy (D.O.) if: your employer offers group health coverage; the doctor has treated you in the past
and has your medical records; prior to the injury your doctor agreed to treat you for work injuries or
illnesses and; prior to the injury you provided your employer the following in writing:
(1) Notice that you want your personal doctor to treat you for a work-related injury or illness and
(2) Your personal doctor’s name and business address.
Primary treating physician (PTP):
injury or illness. This physician writes medical reports that may affect your benefits. Also called treating
physician or treating doctor.
Proof of service:
it has stabilized. See also permanent and stationary.
Qualified injured worker (QIW):
if you were injured before Jan. 1, 2004.
Qualified medical evaluator (QME):
perform medical evaluations.
Qualified rehabilitation representative (QRR):
place disabled workers in new jobs. Also called rehabilitation counselor.
Reconsideration of a summary rating:
mistakes were made in your permanent disability rating.
located within a reasonable commuting distance of where you lived at the time of your injury.
decisions about vocational rehabilitation benefits and helps resolve disputes.
potential settlements of vocational rehabilitation services, and reviews and approves vocational
rehabilitation plans for injuries that happened before Jan. 1, 2004.
Schedule for rating permanent disabilities:
payments and future medical care. Settlements must be reviewed by a workers’ compensation judge to
make sure they are adequate.
Serious and willful misconduct (S&W):
willful misconduct of your employer.
Social Security disability benefits:
benefits come from the U.S. Social Security Administration. They are reduced by workers’ compensation
payments you receive.
burned by a chemical splashed on your skin, getting hurt in a car accident while making deliveries.
State average weekly wage:
California covered by unemployment insurance, as reported by the U.S. Department of Labor. Effective
2006, temporary disability benefit increases are tied to this index.
State disability insurance (SDI):
workers by the state Employment Development Department (EDD). SDI provides short-term benefits to
eligible workers who suffer a loss of wages when they are unable to work due to a non work-related illness
or injury, or a medically disabling condition from pregnancy or childbirth. Workers with job injuries may
apply for SDI when workers’ compensation payments are delayed or denied. Call 1-800-480-3287 for
more information on SDI.
Stipulation with award:
is the document the judge signs to make the award final.
Stipulations with request for award (Stips):
an award. It may include future medical treatment. Payment takes place over time. This document is
provided to the judge for final review.
doctor reports as contributing to a worker’s permanent disability. Subjective factors are given very little
weight under the 2005 rating schedule as the schedule relies mainly on objective measurements.
Subpoena Duces Tecum (SDT):
Summary rating reconsideration:
DWC Disability Evaluation Unit.
Supplemental job displacement benefit (SJDB):
injured in 2004 or later, and 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 stateapproved
or state-accredited schools. Also called voucher.
Temporary disability (TD or TTD):
you from doing your usual job while recovering.
Temporary partial disability (TPD) benefits:
recovering, but you earn less than before the injury.
Temporary total disability (TTD) benefits:
fees related to a claim. Usually a reimbursement.
Uninsured Employers Fund (UEF):
your employer is illegally uninsured for workers’ compensation.
Utilization review (UR):
pay for treatment recommended by your treating physician or another doctor.
Vocational & return to work counselor (VRTWC):
the person or entity that helps you develop a return to work strategy. They evaluate you, provide
counseling and help you get ready to work. A VRTWC must have at least an undergraduate degree
in any field and three or more years of full time experience.
Vocational rehabilitation (VR):
are permanently unable to do your usual job, and your employer does not offer other work, you qualify for
this benefit. It includes job placement counseling to help you find another job. It may also include
retraining and a vocational rehabilitation maintenance allowance.
Vocational rehabilitation maintenance allowance (VRMA):
expenses while participating in vocational rehabilitation. See vocational rehabilitation.
Wage loss (temporary partial disability):
Workers’ Compensation Appeals Board (WCAB):
where disagreements over workers’ compensation benefits are initially heard by workers’ compensation
judges. The WCAB Reconsideration Unit in San Francisco is a seven-member, judicial body appointed by
the governor and confirmed by the Senate that hears appeals of decisions issued by local workers'
Workers’ Compensation Insurance Rating Bureau (WCIRB):
Insurance and funded by the insurance industry, this private entity provides statistical and rating
information for workers’ compensation insurance and employer’s liability insurance, and collects and
tabulates information to develop pure premium rates.
help protect you from further injury.
Workers’ compensation administrative law judge:
workers’ compensation disputes and approves settlements. Judges hold hearings at local Workers’
Compensation Appeals Board (WCAB) offices, and their decisions may be reviewed and reconsidered by
the Reconsideration Unit of the WCAB. Also called workers’ compensation judge.
Workers’ compensation judge
The information contained in this fact sheet is general in nature and is not intended as a substitute for legal advice.
Changes in the law or the specific facts of your case may result in legal interpretations different than those presented
DWC fact sheet B
Website powered by Network Solutions®