| 3rd Party C & R | |
A Compromise and Release of a combination civil and workers' compensation claim where the injury was caused by a person with civil liability to either the employee or employer.
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| 4061 | |
'Labor Code section defining the rights of the parties and procedures where there is a dispute regarding the treating physician's assessment of permanent disability.'
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| 4062 | |
Labor Code section defining the rights of the parties and procedures where there is a dispute regarding the treating physician's assessment of any medical issue other than permanent disability.
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| 4650 | |
Labor Code section that requires the insurance company to increase a temporary disability or permanent disability payment that is late by 10% automatically.
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| 5710 | |
Labor Code section authorizing depositions and mandating reimbursement to injured employees for certain expenses related to the deposition.
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| 5710 Fee | |
The fee payable to the attorney representing an injured worker in a deposition.
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| 5814 | |
Labor Code section mandating an increase of 10% in benefits which are unreasonably delayed or denied. See also 'Penalty'.
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| 90 Day Discovery | |
The time period by which the employer or insurance company has in which to deny a claim before it is rebuttably presumed compensable
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| ACOEM | |
Acronym for American College of Occupational and Environmental Medicine; typically used in reference to the organization's medical treatment guidelines publication (ACOEM Guidelines) used in many workers' compensation systems for directing medical care.
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| ADA | |
Acronym for 'Americans with Disabilities Act'. A Federal law governing the rights of persons with disabilities.
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| Administrative Director | |
The office of the chief executive for the workers' compensation system.
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| Agreed Medical Examination | |
An impartial medical examination that is agreed upon by the parties to resolve a medical dispute. See also Qualified Medical Examination.
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| Alternative Work | |
A term of art in vocational rehabilitation. In lieu of providing vocational rehabilitation, an employer may opt to place the injured worker in a new position subject to the treating physician's approval. See also Vocational Rehabilitation.
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| AME | |
Acronym for 'Agreed Medical Examination'. An impartial medical examination that is agreed upon by the parties to resolve a medical dispute. See also QME.
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| AOE/COE | |
Acronym for workers' compensation term of art: 'Arising Out of Employment or Course of Employment'. To be compensable, an injury must be found to be 'AOE/COE'.
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| Appeals Board | |
Short for 'Workers' Compensation Appeals Board'.
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| Application | |
Short for 'Application for Adjudication of Claim'. A form used to initiate the jurisdiction of the WCAB for litigating a workers' compensation claim.
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| Apportionment | |
Ascribing a portion of permanent disability to another cause, usually a prior injury, that had, or would have, produced some disability independent of the industrial injury.
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| Arbitration | |
An informal dispute resolution method where the issues are decided by a person or panel of persons selected by the parties to resolve a dispute. An alternative to Trial.
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| Arbitrator | |
A person vested with jurisdictional powers to resolve a dispute, make findings and decisions outside of the formal processes established for hearings before the WCAB.
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| Award | |
A final order for the issuance of a workers' compensation benefit. This may be pursuant to a settlement (often called Stipulated Award) or after a hearing/trial. Often, this term is used in conjunction with the device by which it is rendered, such as 'Stipulated Award' or 'Findings and Award'.
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| AWW | |
Acronym for 'Average Weekly Earnings'. All indemnity benefits are determined by a percentage of the average weekly earnings of the injured worker.
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| Bifurcate (bifurcation) | |
A trial of issues seperately. On occasion, where expediency is paramount and the resolution of an issue may be determinative of other issues, the trial judge may order bifurcation.
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| Binding Arbitration | |
An informal dispute resolution method where the issues are decided by a person or panel of persons selected by the parties to resolve a dispute and where the decision is binding on the parties and there is no right of appeal except in very limited circumstances. An alternative to Trial.
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| C & R | |
Acronym for Compromise & Release. The document by which a workers' compensation case is settled in lump sum, typically settling any and all outstanding issues. A case can be settled at virtually any time by C&R, but must be approved by a workers' compensation judge. See also Award.
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| C.T. | |
Acronym for 'Continuous Trauma' - an injury which occurs over the course of time.
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| CAAA | |
Acronym for California Applicants Attorneys Association. A professional organization of attorneys that specialize in the practice of representing injured workers before the California Workers' Compensation Appeals Board.
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| CCC | |
California Compensation Cases. Published by Lexis/Nexis, the standard citation for California workers' compensation case law. Includes both published opinions, and summaries of cases where the appellate courts have denied writs of review (see Writ Denied).
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| CDCDAA | |
Acronym for California Workers' Compensation Defense Attorneys Association. A professional organization of attorneys that specialize in the representation of employers and insurance companies in litigated claims before the California Workers' Compensaiton Appeals Board.
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| Center for Medicare Services | |
The federal agency responsible for management of Medicare. AKA the acronym 'CMS.'
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| Claim Form | |
The form filled out by an injured employee to initiate a workers' compensation claim. This form has important legal ramifications.
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| CMS | |
Center for Medicare Services - the federal agency responsible for management of Medicare.
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| Commutation | |
Reducing a sum of money due at a certain rate, for a period of time, to its present value.
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| Compensable | |
A claim for which workers' compensation benefits are due. See also AOE/COE.
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| Compromise and Release | |
The document by which a workers' compensation case is settled in lump sum, typically settling any and all outstanding issues. A case can be settled at virtually any time by Compromise and Release, but must be approved by a workers' compensation judge. See also Award.
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| Contested Claim | |
A workers' compensation claim where: (1) the employer rejects liability for it; or (2) the employer fails to accept liability for it; or (3) the employer fails to timely respond to a demand for benefits.
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| Continuous Trauma | |
An injury which occurs over the course of time.
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| Coordination of benefits | |
When an individual is covered under two separate policies, benefits are coordinated to avoid paying more than 100 percent of covered services.
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| D.O.I. | |
Acronym for Date Of Injury
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| Date Of Injury | |
The date on which the injury is deemed to have occurred, which may be different than the actual date of an incident producing an injury. This is a term of art in workers' compensation from which certain rights and liabilities of the parties flow.
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| Declaration Of Readiness | |
This is the document that is filed with the WCAB to obtain a hearing date. Also called a 'DOR'
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| Deductible | |
A dollar amount paid by an insured before policy benefits begin. Insurers typically assume the remaining share of costs.
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| Denial | |
The act of denying liability for a claim. See also 'Denial Letter'.
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| Denial Letter | |
The document sent to the employee by the employer or insurance company advising that the claim for workers' compensation benefits has been denied.
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| Deposition | |
The act of taking testimony under oath before a Certified Short-hand or Court Reporter.
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| Direct Costs | |
Those expenses associated with a worker's injury claim, such as lost wages, medical care, fees, and other claims costs. Direct costs are most often the workers' compensation costs employers will tackle because they are the most visible and tangible.
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| Discovery | |
The process of obtaining information about a claim. This includes subpoenaing records, depositions, medical examinations, investigations.
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| DOR | |
Acronym for 'Declaration of Readiness to Proceed'. This is the document that is filed with the WCAB to obtain a hearing date.
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| DWC | |
Division of Workers' Compensation.
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| EAMS | |
Acronym for California's Division of Workers' Compensation Electronic Adjudication Management System - an Internet based case management system for the Workers' Compensation Appeals Board bought on-line in August, 2008 and intended to replace the Electronic Data Exchange (EDEX) system.
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| EDD | |
Acronym for 'Employment Development Department'. A division of the State of California's Department of Industrial Relations charged with the duty of providing disability and unemployment benefits.
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| EDEX | |
DWC's Electronic Data Exchange system whereby a person may send and receive information to and from the DWC electronically. EDEX offers the public user the sole electronic access point to the WCAB's database of past, current, and pending cases.
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| Employee | |
A person who performs services subject to the direction and control of another for compensation.
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| Employer | |
A person or entity subject to the provisions of the workers' compensation laws of the State of California.
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| Expedited | |
A trial on limited issues requiring emergency attention. Issues are generally limited to entitlement to temporary disability indemnity or medical treatment.
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| F & A | |
Acronym for 'Findings and Award'. This is a combination document issued by a workers' compensation judge after a hearing describing the judge's factual and legal determinations, and the Award based on those determinations. See also 'Award'.
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| Fee Schedule | |
Short for 'Relative Value of Services Fee Schedule'. The schedule of medical services and the fees for those services published by the State of California which are presumed reasonable.
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| Fee-for-Service | |
The traditional method doctors and hospitals use for billing health care services; usually the insurance company pays the bill with the addition of a co-payment by the policyholder.
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| Findings & Award | |
This is a combination document issued by a workers' compensation judge after a hearing describing the judge's factual and legal determinations, and the Award based on those determinations. AKA 'F&A'. See also 'Award'.
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| FMLA | |
Acronym for 'Family Medical Leave Act'. Generically refers to both Federal and State laws governing the rights of persons seeking time off of work for certain medical and family situations.
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| Formal Conference | |
A hearing before a Rehabilitation Unit consultant. Vocational rehabilitation disputes have original jurisdiction in the Rehabilitation Unit before a Rehabilitation Consultant. Essentially a 'trial' of rehabilitation disputes. If the dispute is not resolved at this stage then the parties may 'appeal' for a new hearing before a workers' compensation judge.
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| Going & Coming | |
'Going and Coming Rule' - generally an injury is not compensable if it is incurred while the employee is either reporting to work, or is leaving work. There are numerous exceptions
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| Good Cause | |
A term of art in workers' compensation loosely defining a substantive excuse for an act.
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| HCO | |
Health Care Organization. This is a managed medical care model. Special rules apply to medical treatment options through HCOs.
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| HMO | |
Health Maintenance Organization. This is a managed medical care model. Special rules apply to medical treatment options through HMOs.
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| IMC | |
Industrial Medical Council
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| In Propria Persona | |
A legal term of art based in Latin which means 'representing self'. Refers to a litigant who represents himself, and is not represented by an attorney.
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| Indemnity | |
A benefit delivered by payment of money. Distinguished from benefits delivered by a service, such as medical treatment.
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| Independent Contractor | |
A person who provides services on contract to another, uses his or her own tools, and is not subject to the direction or control of the hiring party in the detail or manner of the performance of the work. Compare to 'Employee'.
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| Industrial Injury | |
An injury that occurs during or because of work.
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| Informal Conference | |
An informal meeting of the parties in an attempt to resolve vocational rehabilitaiton disputes. Required before the parties may request a Formal Conference.
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| Initial Aggressor | |
Injuries arising out of an altercation which are sustained by the employee who started the altercation may not be compensable.
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| Interrogatory | |
Formal questions set forth in writing to a witness requiring a response under oath.
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| Knowledge Of Injury | |
Term of art in California workers' compensation. This determines the date from which certain rights and liabilities flow for employer, insurance company and employee. See 'Claim Form'.
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| Lien | |
An assertion of right to payment by a person or entity who is not a party to the injured worker's case.
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| Life Pension | |
A benefit which is a subset of permanent disability indemnity payable to injured workers for life and whose permanent disability exceeds 70%.
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| Longshore and Harbor Workers Act | |
The federal workers' compensation system that has exclusive jurisdiction for longshore, harbor workers, and related industrial injuries.
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| Managed Care | |
An approach to health care that uses such techniques as claims administration, case management, and utilization analysis to control access and costs. Managed care is considered by many to be the key to modern health care reforms. However, the issue of managed care is viewed differently by different industries. Examples of managed care systems are health maintenance organizations and preferred provider organizations.
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| Maximal Medical Improvement | |
See MMI - The medical condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment.
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| Mediator | |
A person selected by parties to litigation to assist in the informal resolution of a dispute. A mediator does not make a decision but assists the parties in settlement.
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| Medical - Legal | |
A report, evaluation, diagnostic study or other medically related service performed or obtained for the purpose of proving or disproving a contested medical issue.
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| Medical Treatment | |
One of the benefits due an injured worker. Must be reasonable and necessary to relieve or cure from the effects of an industrial injury. Distinguished from 'Medical Legal'.
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| Medicare Set Aside | |
A contractual document that establishes a trust, connected to a workers' compensation settlement, that ensures Medicare is reimbursed for treatment expenses paid by Medicare that otherwise should be paid under workers' compensation. AKA by the acronym 'MSA.'
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| MMI | |
Maximal Medical Improvement - The medical condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment.
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| Modified Work | |
A term of art in vocational rehabilitation. In lieu of providing vocational rehabilitation, an employer may opt to modify the duties of the usual and customary occupation of the injured worker subject to the treating physician's approval. See also Vocational Rehabilitation.
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| MSA | |
Medicare Set Aside - a contractual document that establishes a trust, connected to a workers' compensation settlement, that ensures Medicare is reimbursed for treatment expenses paid by Medicare that otherwise should be paid under workers' compensation.
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| MSC | |
Acronym for Mandatory Settlement Conference. The Labor Code requires that litigants participate in a conference in an attempt to settle cases before they may proceed to trial.
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| New & Further | |
An allegation that a condition which was previously permanent and stationary has deteriorated necessitating a reassessment of permanent disability. See also 'Petition to Reopen'.
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| Notice | |
The act of giving information to a party.
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| OCR | |
Acronym for Optical Character Recognition - the process or technology of reading data in printed form by a device (optical character reader) that scans and identifies characters; a key technology used by the California EAMS system for data input by scanning paper files produced by case parties.
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| OSHA | |
Occupational Safety and Health Administration
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| OTOC | |
Acronym for 'Ordered Taken Off Calendar' - a disposition ordered by a workers' compensation judge after a hearing where no further action is necessary on the part of the WCAB.
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| P & S | |
Describes a medical condition which is not expected to get appreciably better or worse. A prelude to permanent disability. Same as 'Permanent and Stationary'.
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| PD or PPD | |
Permanent Disability or Permanent Partial Disability Indemnity.
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| PDR | |
Permanent Disability Rating.
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| Penalty | |
An increase of a benefit due to the unreasonable failure or refusal by an employer or insurance company to provide a benefit that is due.
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| Permanent & Stationary | |
Describes a medical condition which is not expected to get appreciably better or worse. A prelude to permanent disability. The same as 'P&S'.
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| Permanent Disability | |
An assessment of disability which is not expected to change dramatically and upon which permanent disability indemnity is based. See also permanent disabiliy rating and permanent & stationary.
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| Permanent Disability Rating | |
The numerical assessment of a physician's description of an injured worker's permanent disability. This is derived by applicant of the functions in the permanent disability rating manual to the language used by the physician to describe the disability, usually involving workers' compensation terms of art.
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| PERS | |
Public Employees' Retirement System.
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| Petition For Reconsideration | |
A petition to the WCAB to review a final order, award or decision of a workers' compensation judge.
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| Petition For Writ of Review | |
A request to the State Appellate or Supreme Court to review a decision of the WCAB after Reconsideration. See also Reconsideration.
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| Petition to Reopen | |
The document filed with the WCAB and insurance company alleging a change in conditions following an Award, and requesting the WCAB to revisit issues in the case. See also 'New & Further'.
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| Post Termination | |
Some claims may be barred if they are made following a termination of employment.
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| PPO | |
The preferred provider organization is a form of managed health care through which subscribers choose their own doctors and care centers and a menu of benefits.
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| PR-1 | |
A form also known as the Doctor's First Report of Injury. This is a form that physicians are required to fill out and file with the insurance company within 5 days of seeing an industrially injured worker.
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| PR-2 | |
A form physicans may use to report medical activity regarding an injured worker. Physicians are required to report at intervals of at least 45 days when actively treating an injured worker.
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| Primary Physician | |
The physician elected by the injured worker primarily responsible for managing his or her medical treatment where more than one physician or specialist is involved.
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| Proximate Cause | |
The direct cause of the incident giving rise to legal liability.
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| QIW | |
Acronym for 'Qualified Injured Worker' - a term of art describing eligibility for vocational rehabilitation.
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| QME | |
Acronym for 'Qualified Medical Examination'. Depending on whether an injured worker is represented by an attorney or not, this may be either an impartial medical examination by a doctor selected by the injured worker from a State provided panel, or an examination set up by an attorney specifically for the purpose of proving a contested medical issue. See also AME.
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| QRR | |
Qualified Rehabilitation Representative
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| Qualified Medical Examination | |
Depending on whether an injured worker is represented by an attorney or not, this may be either an impartial medical examination by a doctor selected by the injured worker from a State provided panel, or an examination set up by an attorney specifically for the purpose of proving a contested medical issue. See also Agreed Medical Examination.
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| Rating | |
A calculation of the percentage of permanent disability.
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| Reconsideration | |
When the WCAB reviews a final order, award or decision of a workers' compensation judge.
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| Referee or WCR | |
Workers' Comp Referee, see 'Judge,' or 'WCJ,' L.C. Sect. 27.
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| Regulations | |
Rules and Regulations of the Administrative Director, Title 8 California Code of Regulations. Also referred to as 'Rules' or 'Administrative Code'
|
| Rehabilitation | |
A formal document outlining the vocational rehabilitation efforts which will be made to return the injured worker to gainful employment.
|
| Rodgers | |
Refers to a preeminent case which held that injuries sustained while an injured worker was participating in vocaitonal rehabilitation are compensable. See also 'Rodgers Waiver'.
|
| Rodgers Waiver | |
A stipulation whereby the injured worker gives up any right to seek workers' compensation benefits for any injuries that may be sustained while participating in vocational rehabilitation. See also 'Rodgers'.
|
| RU-103 | |
A form required to request a Formal Conference before the Rehabilitation Unit.
|
| Rules | |
Rules and Regulations of the Administrative Director, Title 8 California Code of Regulations. Also referred to as 'Administrative Code' and 'Regulations.'
|
| RVS Fee Schedule | |
RVS is an acronym for 'Relative Value of Service'. This is a published schedule of presumed minimum values of medical services which serves as a guideline for payment of medical services by insurance companies.
|
| SCIF | |
State Compensation Insurance Fund, pronounced 'skiff'
|
| Self Insurance | |
A program whereby the employer essentially acts as its own insurance company and is subject to the jurisdiction of the Insurance Commissioner.
|
| Self-Procured | |
Medical treatment of employee which has not been authorized by the employer
|
| Service | |
The act of delivering a document to a party in litigation in accordance with the rules of procedure governing the litigation.
|
| SGE | |
Suitable Gainful Employment
|
| SIF | |
Subsequent Injuries Fund
|
| SOL | |
Statute of Limitations
|
| Specific Injury | |
An injury which occurs at a particular, defined moment in time. A one-time injury.
|
| SSA | |
Social Security Administration
|
| SSD | |
Social Security Disability
|
| SSI | |
Supplemental Security Income (Social Security)
|
| SSN | |
Social Security Number
|
| Standard Rating | |
A level of PD before adjusting for age and occupation
|
| State Disability | |
Payments by the Employment Development Dept. (EDD)
|
| Statute of Limitations | |
General time restrictions against filing or making a claim for benefits.
|
| Stip or Stips | |
Stipulations with Request for Award, signed by the parties. Following approval by the WCAB, 'and Award' is added.
|
| Sub Rosa | |
Latin for 'under cover'. Short for 'sub rosa investigation'. Typically refers to an undercover investigation which involves obtaining filmed evidence.
|
| Sub Rosa Investigation | |
An undercover investigation which typically involves obtaining filmed evidence. Sub Rosa is Latin for 'under cover'.
|
| Subpoena | |
A document certified by a workers' compensation judge requiring the presence of awitness to give testimony, or the production of documents or other physical things (subpoena duces tecum). Can also be a verb: 'Subpoena the witness to trial.'
|
| Substantial Evidence | |
Evidence that a reasonable mind might accept as adequate to support a conclusion. It is not the best or most evidence. So long as when the record as a whole is reviewed, there is enough evidence to upon which a decision may reasonably be made.
|
| Sumner | |
A preeminent case dictating that dependents of an injured worker are entitled to death benefits in the event the industrial injury leads to the injured worker's death.
|
| TD, TTD or TDI | |
Temporary Total Disability Indemnity
|
| Thomas | |
A preeminent case providing that vocational rehabilitation rights cannot be waived unless there is evidence that would be sufficient to defeat a workers' compensation claim of injury on AOE/COE grounds. See also 'AOE/COE'.
|
| Tort | |
A civil claim, e.g., for negligent operation of a motor vehicle causing a personal injury
|
| TPA | |
Third Party Administrator - a company or party under contract with an insurance company or employer to administer and/or manage claims.
|
| TPD | |
Temporary Partial Disability Indemnity
|
| Treating Physician | |
A physician elected by the injured worker responsible for medical treatment.
|
| Treating Physician Presumption | |
For injuries occuring after 1/1/94, the medical reports of the physician primarily responsible for managing the treatment of the injured employee have a presumption of correctness on all medical issues, but which may be rebutted by an opinion from a Qualified Medical Examiner or Agreed Medical Examiner.
|
| Trial | |
A hearing on issues in dispute before a workers' compensation judge.
|
| U & C | |
Usual and Customary employment
|
| UEF | |
Uninsured Employers Fund
|
| Vocational Rehabilitation | |
An entitlement to injured workers who are precluded from returning to their usual and customary occupation due to disability arising out of a work injury. See also QIW.
|
| VRMA | |
Acronym for 'Vocational Rehabilitation Maintenance Allowance' - the weekly indemnity paid an injured worker while participating in vocational rehabilitation.
|
| WCAB | |
Acronym for 'Workers' Compensation Appeals Board'. Though this term technically describes the official administrative body charged with oversite of the adjudicatory arm of the Department of Industrial Accidents for workers' compensation claim, it is used synonymously to describe local 'trial level' jurisdictions.
|
| WCJ | |
Workers' Compensation Judge, changed to 'workers' compensation administrative law judge' (L.C. Sect. 27), but 'WCJ' or 'Judge' is used almost exclusively. Also, 'WCR,' or 'Workers' Compensation Referee' is used synonymously.
|
| WCR | |
Workers Compensation Referee; see 'WCJ,' supra.
|
| Writ | |
Petition for Writ of Review, the second level of appeal to a District Court of Appeal following an unsuccessful Petition for Reconsideration to the WCAB.
|
| Writ Denied | |
Order from an Appellate Court, or the Supreme Court, when the court refuses to hear a case where one or more parties have filed a Petition for Writ of Review. Writ Denied CCC (see CCC in this glossary) is not precedence nor is it citable in legal documents because it is not a court opinion, merely a summary of the papers filed with the Appellate or Supreme Court seeking the issuance of a Writ of Review.
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| Writ of Review | |
An order of a State Appellate Court or the Supreme Court whereby a decision of the WCAB will be reviewed.
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