California Workers' Compensation Terms and Abbreviations

132(a) L.C. – Law that prohibits discrimination against an employee because he/she filed a workers’ comp claim

5020 Form – Employer’s First Report of Occupational Injury or Illness

5500.5 L.C. – Cumulative Trauma Injuries

5814 L.C. – Penalty for unreasonable delay or refusal of payment of compensation

A/A – Applicant's Attorney

ACOEM – American College of Occupational & Environmental Medicine

A.D. – Administrative Director of the Division of Workers’ Compensation (DWC)

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

AMA – American Medical Association

AME – Agreed Medical Evaluation performed by an Agreed Medical Evaluator. A physician selected by an attorney and the claims administrator, who conducts a medical evaluation to resolve a dispute and submits a comprehensive report to the parties.

AOE/COE – Arising out of and occurring within the course and scope of employment

APP – Application for Adjudication of Claim

Appeals Board – Workers’ Compensation Appeal Board includes Commissioners in San Francisco and district offices all over California

Applicant – Party, usually employee, who files an “Application for Adjudication of Claim” with the Workers’ Compensation Appeal Board

Apportionment – Determination of how much of a permanent disability is due to the industrial injury and how much is due to other disabilities or other underlying medical conditions

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.

Award – Award by WCAB as in “Findings & Award”

AWW – Average Weekly Wage

Cal/OSHA – A unit within the state Division of Occupational Safety and Health. Cal/OSHA inspects workplaces and enforces laws to protect the health and safety of workers in California.

C&R – Compromise and Release: Settlement where the applicant releases all claims against the employer in exchange for a sum of money. A C&R must be approved by a Workers’ Compensation judge.

CHSWC – Commission on Health and Safety and Workers’ Compensation

Clmt – Claimant, Employee, Applicant, Injured worker

Commutation – An order by a Workers’ Compensation Administrative Law Judge for a lump sum payment of part or all of a permanent disability award

COLA – Cost of Living Adjustment

CT – Cumulative Trauma: §L.C. 5500.5. An injury or illness that occurs over a period of time. For example, Carpal Tunnel Syndrome, back complaints resulting from “micro traumas”.

D.E.U. – Disability Evaluation Unit

DOI – Date of Injury

Death Benefits – Benefits paid to surviving dependents if the cause of death is a result of a work-related injury or illness

Defendant – The employer or his/her representative, usually the insurance company

Demand – An “Offer” to settle made by the employer or representative. “Offers” come from defendants and “Demands” from employees.

Deposition – A formal session in which an attorney asks questions of a party under oath. 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.

DEU – Disability Evaluation Unit: A unit within DWC that calculates the percent of permanent disability based upon the medical reports

Discrimination Claim – (Labor Code 132a): A petition filed by an employee alleging he/she was terminated or discriminated against by the employer because of the industrial injury. This is not insurable.

DIR – Department of Industrial Relations

DOR – Declaration of Readiness to Proceed: A form to request a hearing before a Workers’ Compensation Administrative Law Judge in order to resolve a dispute

DWC – Division of Workers’ Compensation

DWC-1 Form – Employee’s Claim Form for Workers’ Compensation Benefits

DX – Diagnosis

EAMS – Electronic Adjudication Management System: Division of Workers’ Compensation’s computer based system

EDD – Employment Development Department

EE – Employee or Injured worker

ER – Employer

Evidence Based Medicine (EBM) – The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual injured persons entitled to benefits

FCE – Functional Capacity Evaluation

F&A – Findings & Award: A Workers’ Compensation Administrative Law Judge’s decision finding that an applicant is entitled to disability benefits payments, future medical treatment, or both

F&O – Findings & Order: A Worker’s 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, splinter, etc., which do not ordinarily require medical care. The one-time treatment 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

Going & Coming Rule – Injuries during a normal commute are not industrial, with exceptions

Hearings – Formal proceedings held at the Worker’s Compensation Appeals Board (WCAB) before a Workers’ Compensation Administrative Law Judge

I&A – Information & Assistance Officer: Assists injured workers at the WCAB

IBR – Independent Bill Review: A process to resolve billing disputes through an independent third party contracted by DWC

IME – Independent or Impartial Medical Examiner, not one chosen by a party, as in tort

IMR – Independent Medical Review: A process to resolve medical treatment issues through an independent third party contracted by DWC

In Pro Per – An individual representing themselves. No Attorney involvement.

Indemnity Chain – A claim that is reserved in which the reserves may include temporary or permanent disability, medical, supplemental job displacement benefit (SJDB), and expense

JD – Job Description: also known as “Description of Employee’s Job Duties”

LC – California Labor Code (L.C)

LDW – Last Day Worked

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

Light Duty/Modified Duty – Temporary change in job assignment to accommodate work restrictions while injured worker is healing

Lit – Litigated Claim: A workers’ compensation claim where an Application for Adjudication has been filed

Maximus – The administrative director has designated Maximus to conduct all Independent Medical Reviews and Independent Bill Reviews

Med/Legal – Medical/Legal examination that helps clarify disputed issues. Cost paid by employer under L.C. 4620-4622

Medical Treatment – Treatment reasonably required to cure or relieve from the effects of a work-related injury or illness

Modified Work – A medical restriction that would allow an injured worker to return to work, but not at their usual and customary job duties. The work restrictions may be temporary or permanent.

MMI – Maximum Medical Improvement: Condition is stable and unlikely to change. Also referred to as Permanent & Stationary “P&S”.

MO – Medical Only Claim: A claim with a limited medical reserve

MPN – Medical Provider Network: An entity or group of health care providers set up by an insurer, self-insured employer or Network Service Entity (NSE) and approved by the California Division of Workers’ Compensation (DWC) administrative director to treat workers injured on the job. Under state regulations, each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses.

MSC – Mandatory Settlement Conference: A required conference to discuss settlement of disputed issues prior to a trial

MTUS – Medical Treatment Utilization Schedule

NOARFI – Notice of Assignment and Request for Information

NLT – No Lost Time

N&F – New & Further: Petition filed with the WCAB to Reopen for New & Further Disability

OAC&R – Order Approving Compromise and Release

OBAE – Office of Benefit Assistance and Enforcement

OMFS – Official Medical Fee Schedule

PD – Permanent Disability: Permanent Impairment determined by a physician upon the injured worker reaching Maximum Medical Improvement (MMI)

PDA – Permanent Disability Advance: A voluntary advance payment on permanent disability due in the future. The payment may be made in a lump sum or bi-weekly.

PDP – Permanent Disability Payments: Bi-weekly payments on the undisputed portion of the permanent disability, prior to or subsequent to an award

PDR – 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 – Appeal (i.e.): Petition for Recon, a Writ of Review, or for an enforcement of Award

PBM – Pharmacy Benefit Manager: A third party administrator of prescription drug programs

Physician – A California licensed physician, surgeon, psychologist, optometrist, dentist, podiatrist, osteopaths, chiropractic practitioners, or acupuncturists

POA – Plan of Action

PPO – Preferred Provider Organization

PQME – Panel Qualified Medical Evaluator: Physician selected from a panel provided by the A.D. to examine the injured worker to resolve AOE/COE, medical and benefit disputes

Predesignated Physician – A Primary Treating Physician that can initially treat an injured worker if they have advised the employer in writing prior to the injury or illness. The injured worker must have seen the predesignated physician prior to selection.

PTP – Primary Treating Physician: The doctor who has overall responsibility for treatment of your industrial injury or illness

POS – Proof of Service: A form used to show that documents have been sent to specific parties

QME – Qualified Medical Evaluator: Independent physician certified by the DWC Medical Unit to perform medical evaluations

Recon – 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

RFA – Request for Authorization form: Physicians are required to request their proposed treatment via RFA to the carrier for review

RTW – Return to Work

SAWW – State Average Weekly Wage paid to employees as reported by the Department of Labor. TTD, Life Pension and Death Benefits increases are tied to this index.

SBR – Second Bill Review: Provider can request a Second Bill Review to dispute the payment made by the claims administrator. (This process must be completed before a provider can seek Independent Bill Review of a billing dispute.)

SDT – Subpoena Duces Tecum: A legal document that requires records to be sent to the requester

SIU – Special Investigations Unit

Self-Procured – Medical treatment of an employee, not authorized by the employer/insurer

S&W – Serious and Willful Misconduct: A petition filed if the injury is caused by the serious and willful misconduct of the employer or injured worker. This is not insurable!

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 payment. A Stipulation may leave certain issues open, such as future medical treatment and/or vocational rehabilitation.

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

SIF – Subsequent Injuries Fund

SIP – Self-Imposed Penalty

SJDB – Supplemental Job Displacement Benefit: Effective for injuries on or after 01/01/2004. Also known as “Voucher”.

SOL – Statute of Limitations

Stip – Stipulation with Request for Award: A settlement wherein the parties agree on the terms of an award. It may include any future medical treatment. (Requires judge’s approval.)

Sub Rosa – Private investigation usually entails video showing employee’s activity

Subpoena – A document that requires a witness to appear at a hearing. There must be an Application for Adjudication on file for a subpoena to be valid.

Subrogation – To seek recovery against a negligent third party

Summary Rating Reconsideration – An administrative procedure to object to the summary Permanent Disability Rating issued by the DWC Disability Evaluation Unit. The request must be made within 30 days of receipt of the summary rating.

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 by an attorney.

SX – Surgery

TTD – Temporary Total Disability: A wage replacement benefit paid when an employee, upon medical verification, cannot work as a result of an industrial injury or illness

TPD – Temporary Partial Disability: A wage replacement benefit paid when an employee returns to work on a temporary modified employment basis, earning less than pre-injury earnings. (Also 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

TX – Treatment

U&C – Usual and Customary employment and/or Usual Customary Medical fees from a provider

UEF – Uninsured Employers Fund; if employer is illegally uninsured, the state fund may provide benefits to injured worker

UR – Utilization Review Organization

W.P. – Waiting period until eligible for first temporary disability payment

WCAB – Workers’ Compensation Appeals Board

WCIS – Workers’ Compensation Information System

WCIRB – Workers’ Compensation Insurance Rating Bureau

WCJ – WCAB Judge/Referee

WPI – Whole Person Impairment

Writ – Writ of Review, 2nd level of appeal

Medical Terms and Abbreviations

Abrasion – Scrape

ADL – Activities of Daily Living

Avulsion – A wound caused by tearing of the tissue

Cartilage – Cushion type tissue between bones

Cervical Vertebrae – Vertebrae in the neck region

Clavicle – Collar bone

Coccyx – Tail bone – part of the sacrum

Comorbidity – The presence of one or more additional disorders/diseases co-occurring with a primary disorder/disease

Contusion – Bruise

COPD – Chronic Obstructive Pulmonary Disease

CRPS – Complex Regional Pain Syndrome (AKA Reflex Sympathetic Dystrophy “RSD”)

CTS – Carpal Tunnel Syndrome

CTR – Carpal Tunnel Release

Debridement – Removal of foreign matter or dead tissue from a wound

Diabetes – High blood sugar levels

D.C. – Doctor of Chiropractic

D.D.S., D.M.D – Dentist

D.P.M – Doctor of Podiatric Medicine

D.O. – Doctor of Osteopathy

DX – Diagnosis

DVT – Deep Vein Thrombosis

ENT – Ear/Nose/Throat Doctor

Femur – Thigh bone

FX – Fracture

Hypertension – Elevated Blood Pressure

Humerus – Bone of the upper arm

Intravenous – Into the vein

Laceration – Cut, as in with a knife or sharp object

Ligament – Attaches to the bone

Lumbar Vertebrae – Vertebrae in the lower back

LBP – Lower Back Pain

M.D. – Medical Doctor

Metacarpals – Bones in the hand

Obesity – Accumulation of excess body fat to the extent that it may have a negative effect on health

P.T. – Physical Therapy

PRN – As needed

Paraplegia – Paralyzed below the arms

Pelvis – Hip bone

Phalanges – Bones of the fingers or toes

Psyche – Psychiatric/Psychiatrist/Psychologist

Quadriplegia – Paralyzed from the neck down

Radius/Ulna – Two bones of the lower arm

ROM – Range of Motion

RX – Prescription

Sacrum – Fused part of the spine below lumbar vertebrae

Scapula – Shoulder blade

Sternum – Breast bone

Subcutaneous – Under the skin

SX – Surgery

Tendon – Attaches muscle to bone

Thoracic Vertebrae – Vertebrae in the chest region

TX –Treatment