Glossary 2017-03-24T01:28:31-07:00

Glossary

A

Agreed Medical Evaluator (AME): An agreed medical evaluator is a specific doctor chosen by both your attorney and the insurance company to perform the medical examination and prepare a medical-legal report to help resolve your workers compensation dispute.

Applicant: The party, typically the injured worker, that opens a workers compensation case at the Workers’ Compensation Appeals Board by filing an application for adjudication of claim.

Application: A form that must be filed with the local Worker’s Compensation Appeals Board office to open a workers compensation case if you have a disagreement with the insurance provider about your claim.

Apportionment: The determination of how much of your permanent disability is related to your injury at work and how much is due to other disabilities.

C

Compromise and Release: A settlement in which the person who filed the workers compensation claim is given a lump sum payment and is made responsible for all future medical related care and expenses.

Cumulative Injury: An injury that is caused by repeated activity or exposures while on the job. Example: Losing your hearing from constant exposure to loud noise.

D

Declaration of Readiness: A required form used to request a hearing before a workers compensation judge in order to resolve a dispute.

M

Mandatory Settlement Conference: A conference that is required to discuss a settlement prior to a trial.

Medical-Legal Report: A legal report that is written by a doctor to help describe your medical condition and clarify the disputed medical issues experienced.

Medical Provider Network (MPN): An individual or group of health care providers set up by an employer and approved by DWC’s administration to treat workers who are injured at work. List of healthcare providers:

Medical Treatment Utilization Schedule (MTUS): In California, doctors must provide a schedule for evidence-based medical treatments that are proven to cure or relieve any injuries or illnesses sustained at work. The MTUS must contain a clear set of guidelines that provide details on which treatments are effective for certain injuries or illnesses, how often the treatment must be given and for how long it must be given.

P

Panel Qualified Medical Evaluator (QME): Three independent medical evaluators issued by the DWC Medical Unit that you must select from for your workers compensation evaluation.

Permanent and Stationary (P&S): The point in which your medical improvement has reached a maximum and begun to stabilize. At this stage, a doctor can then provide a written medical report assessing how much permanent damage was the result of an injury at work.

Permanent Disability Rating: The estimated percentage of how much a work injury permanently limits your ability to do your work.

Permanent Disability Benefits (PD): Payments that are received when you have been permanently injured at work and this injury limits your ability to work or earn a living.

Primary Treating Physician (PTP): The physician that has the overall responsibility of treating your work injury or illness.

Q

Qualified Panel Medical Evaluator (QME): A DWC certified independent physician that performs your medical evaluations.

S

State Disability Insurance (SDI): Partial wage-replacement insurance plan that provides short-term benefits to eligible workers in California who have suffered a loss of wages due to the inability to work because of illness or injury.

Stipulations with Request for Award (Stips): A type of settlement in which both parties agree to the terms of an award. Typically including future medical treatments and payments over a period of time.

Supplemental Job Displacement Benefit (SJDB): A workers compensation benefit that promises to help pay for educational or skill retraining in the event you are not able to return to your normal occupation due to injury or illness.

T

Temporary Disability (TD or TTD): Workers Compensation payments that are received if you are not able to work at all during your recovery.

U

Utilization Review (UR): The process in which insurance companies determine whether or not to authorize and say for the doctor recommended treatment.

W

Workers Compensation Appeals Board (WCAB): An appeals board in which disagreements over workers compensation benefits are initially heard by workers compensation judges from over 23 local offices.