ADR. Alternative Dispute Resolution - available to employers with Union employees; reduces or eliminates litigation and uses an Ombudsman instead of the Workers’ Compensation Appeals Board.

ACOEM. American College of Occupational and Environmental Medicine. Medical protocols for treatment.           

AOE/COE. Injury Arising Out Of Employment, and occurring in the Course of Employment (both AOE and COE are required for a compensable injury).        

Alternate Work.  A different job with your employer when you are found to have work restrictions which prevent you from returning to your usual and customary job.               

AMA Guides- 5th Edition. California's basis for determing Permanent Disabiltiy  

Apportionment. A portion of permanent disability may be applied to pre-existing causes or condition.    

Applicant. The party, usually the injured worker, who establishes a case before the Workers’ Compensation Appeals Board.  

Application. A form that establishes a case & a case number with the Workers’ Compensation Appeals Board.     

AA. Applicant’s Attorney - Legal counsel representing the injured worker.            

Audit Unit. A unit within DWC that receives complaints against claims administers. Complaints may lead to an investigation or audit of the company’s claim handling practices.          

AME. Agreed Medical Evaluator - Doctor agreed to by applicant (injured worker) and defense (insurance carrier) to resolve issues.  

C&R. Compromise and Release - A full and final settlement of an injury claim, approved by a judge of the Workers’ Compensation Appeals Board. For a financial consideration, the carrier/employer is relieved of all or a portion of future liability on a loss.

Claims Administrator. The term for insurance adjuster or third-party administrator who handles your workers’ compensation claim.      

Consultative Rating. A rating of permanent disability provided by the DWC Disability Evaluation Unit (DEU) 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 has occurred over a period of time. Legal period of a cumulative trauma claim is one year from the date of knowledge and disability.        

DA. Defense Attorney – Legal counsel representing the insurance carrier/employer.        

Death Benefits. Benefits paid to surviving dependents if a work-related injury or illness results in death within five years.   

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.          

Discrimination Claims.  Labor Code section 132a – A petition filed alleging the employer has discharged or otherwise discriminated against an employee for an industrial injury.      

DOR or DR. Declaration of Readiness – A form to request a hearing before a workers’ compensation administrative law judge in order to resolve a dispute.

DEU. Disability Evaluation Unit - A state agency which evaluates a medical report and calculates an advisory permanent disability rating.        

DWC-1. California Employee Claim Form. www.dir.ca.gov/dwc/DWCForm1.pdf    

DWC. Division of Workers’ Compensation.   www.dir.ca.gov/dwc                

Expedited Hearing. A conference set quickly based on filing of a DOR by one Party, usually on the issues of AOE/COE (compensability) or TTD.              

F&A. Finding and Award - A Workers’ Compensation judge’s decision following a trial.     

FEHA. Fair Employment and Housing Act. www.dfeh.ca.gov           

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. Labor Code 5401 (a).

Fraud. Any knowingly false or fraudulent material statement for the purpose of obtaining or denying workers’ compensation. 

Future Medical. On-going lifetime entitlement to medical treatment for a work related injury per a Stipulated Award.                

In Pro Per. An injured worker or other party who is not represented by an attorney.        

I&A. Information & Assistance – A unit within DWC that provides information to all parties and informally resolves disputes.             

IBR. Independent Bill Review – new requirements for medical providers for injuries on or after 1/1/13 and bill disputes after 7/1/13 regardless of injury date.    

IMR. Independent Medical Review – LC4610.5 and LC4610.6 – all disputes concerning medical care denied by UR to be resolved solely by IMR process for dates of injury on or after 1/1/13 and for all UR disputes after 7/1/13 regardless of injury date.     

JA. Job Analysis - A detailed description of a job, usually developed by a vocational counselor.     

J.D. Job Description - Usually completed by the employer and employee often utilizing the state form, commonly called an RU-91. www.dir.ca.gov/dwc/dwcformru91.pdf

Lien. A right or claim for payment against a workers’ compensation case.              

Light Duty. Temporary change in job assignment to accommodate work restrictions. 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.  

MSA. Medicare Set Aside – A future medical cost estimate required for all Medicare eligible injured workers when a buyout of future medical is considered in a C&R. Must be approved by CMS, Center for Medicare Services.            

Medical Treatment. Treatment reasonably required to cure or relieve from the effects of a work-related injury or illness, now subject to Utilization Review and the ACOEM Guidelines or other evidence based medicine.

Modified Duty. A change in working conditions in order to accommodate work restrictions determined by a primary treating physician.          

MMI. Maximum Medical Improvement – The point where an injury and treatment has stabilized – temporary disability payments cease, and permanent disability may be advanced.  (Same as Permanent and Stationary)       

M.S.C. Mandatory Settlement Conference – A required conference to discuss settlement of disputed issues prior to a trial. Discovery is closed after the MSC. 

M.P.N.  Medical Provider Network – Effective 1/1/05 – network of physicians approved by the Administrative Director.                

NSAID.  Non-steroidal anti-inflammatory medication.     

O.T.O.C. Order Taken Off Calendar – An order that places a WCAB case in an inactive status.        

P.D. or PPD. Permanent Disability - The benefit paid of impairment resulting from an industrial injury or occupational disease of any bodily or mental function which remains after maximum recovery and which causes diminishment of earning capacity, diminishment of normal use of a member or competitive handicap in the open labor market.   

P.D.A. Permanent Disability Advance - Payment on permanent disability due in the future.           

Petition for Reconsideration. 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 an employee who has advised the employer in writing prior to the industrial injury or illness.            

P&S. Permanent and Stationary - The point of recovery from an injury when the employee has reached Maximum Medical Improvement and has stabilized. Temporary Disability payments cease as of this date.   

PTP. Primary Treating Physician – The doctor who has overall responsibility for treatment of industrial injury or illness. There can only be one PTP at a time.      

QME or PQME. Qualified Medical Evaluator - A doctor the State has determined as qualified to evaluate the injured worker, usually for purposes of addressing permanent disability and future medical treatment and other medical/legal issues.  Panel QME refers to the list of “panel” physicians sent by the State to the claimant.          

SB863. New Laws scheduled to take effect 1/1/13 (WC Reform)

SDI. State Disability Insurance – A branch of the Employment Development Department that pays temporary disability benefits for non-industrial injuries or illnesses.   

Sequella. A secondary consequence.  Usually applies to an additional body part to an already compensable claim.                

S&W. Serious and Willful Misconduct – A petition filed if the injury is caused by the serious and willful misconduct of the employer or the injured worker. Penalty up to 50% of benefits. (Not covered by WC policy)   

SJDB. Supplemental Job Displacement Benefit – Vouchers to be used for education or retraining for injuries on or after 1/1/04.  The amount of the voucher varies depending on the level of permanent disability.  $6,000 for injuries after 1/1/13. www.dir.ca.gov/dwc/SJDB.html                 

Settlement. A workers’ compensation case 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 of money. A stipulation may leave certain issues open, such as future medical treatment and the right to file for New and Further disability within 5 years of the date of injury.  

STIPS. Stipulations and Request for Award - A settlement usually providing for permanent disability and future medical care.    

SUBRO. Subrogation - Right of insurance carrier or employer to recover from a responsible third-party for Workers’ Compensation benefits paid to an injured worker.           

SUBROSA. An “undercover” investigation or surveillance utilized if an injured worker is suspected of exaggerating medical symptoms.        

Summary Rating. The percentage of permanent disability calculated by the DWC Disability Evaluation Unit based on either the primary treating physician or a panel QME. This type of rating is only available for workers not represented.                 

T.D. or T.T.D. Temporary Disability or Temporary Total Disability - Weekly payments in lieu of salary.       

TPD. Temporary partial disability – A wage replacement benefit that may be paid when a worker returns to work but at less than full earnings. Sometimes referred to as Wage Loss. 

U&C. Usual and Customary. Job duties held at the time of injury.               

UR. Utilization Review – process required as of 1/1/04 where medical treatment requests are reviewed for authorization by qualified medical personnel who can approve or disapprove the requested treatment based on scientific based medical evidence, such as ACOEM or AMA guidelines.    

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.       

WCAB. Workers’ Compensation Appeals Board - The legal body that resolves Workers’ Compensation disputes. 

Workers’ Comp Administrative Law Judge or WCJ. Judges at DWC district offices that conduct hearings, take evidence, issue decisions, and approve settlements.       

X-Mod. Experience Rating Modifier. A factor expressed as a percentage of an employer's experience based on payroll and losses over a three-year period.  www.wcirbonline.com          

5020. Employer’s First Report of Injury or Illness. www.dir.ca.gov/DOSH/DoshReg/Form5020.pdf

5021 or DFR. Doctor’s First Report of Injury or Illness. www.dir.ca.gov/OPRL/dlsrform5021.pdf