Primary Treating Physician (PTP)
The physician who has primary responsibility for managing the medical care of an injured worker. The PTP writes reports, requests authorization for treatment, determines work restrictions, and...
Workers' Compensation Glossary
Plain-language definitions of 215+ California workers' compensation and personal injury terms. Understanding these terms can help you navigate your claim more effectively.
Showing 215 terms
AMA Guides
The American Medical Association's Guides to the Evaluation of Permanent Impairment (5th Edition) is the standard used in California to determine whole person impairment (WPI) for workers'...
AME (Agreed Medical Evaluator)
A physician both sides agree on to settle disputed medical issues. Used in represented cases, and the opinion carries significant weight.
AOE/COE
Arising Out of Employment / Course of Employment. These are the two legal tests that must be met for an injury to be compensable under workers' compensation. AOE means the injury was caused by the...
Accepted Claim
A workers' compensation claim that the insurance carrier has formally accepted as compensable, acknowledging that the injury or illness arose out of and in the course of employment.
Adjuster
An insurance professional who investigates workers' compensation claims, determines coverage, evaluates damages, and authorizes payment of benefits. Adjusters work for insurance carriers or...
Admitted Liability
When the workers' compensation insurance carrier accepts responsibility for a claim and agrees to provide benefits. Once liability is admitted, the insurer must provide all required benefits unless...
Adverse Inference
A legal presumption that missing evidence would have been unfavorable to the party who failed to produce it. In workers' compensation, adverse inferences may be drawn when an employer fails to...
Aggravation
The worsening of a pre-existing condition due to a work-related injury or exposure. An employer takes the employee as they find them, meaning they are liable for any aggravation of pre-existing...
Alternative Work
A job offered by the employer to an injured worker that accommodates their medical restrictions. The job must be within the worker's physical capabilities and pay at least 85% of their pre-injury...
Applicant
The injured worker who files a workers' compensation claim. Once a claim is filed with the WCAB, the injured worker is referred to as the 'applicant' in all legal proceedings.
Apportionment
The allocation of permanent disability between work-related causes and non-industrial causes (such as pre-existing conditions, aging, or other injuries). Apportionment reduces the employer's liability...
Arbitration
A dispute resolution process where a neutral arbitrator hears evidence and makes a binding decision. Some personal injury cases are subject to mandatory arbitration based on contractual agreements or...
Assumption of Risk
A defense asserting that the plaintiff voluntarily assumed a known risk of injury. In California, primary assumption of risk is a complete defense in sports and recreational activities, while...
Average Weekly Wage (AWW)
Pre-injury earnings used to set disability benefit rates. Labor Code section 4453(c) provides four methods, not one formula.
Benefit Notice
A written communication from the claims administrator informing the injured worker of benefit payments, delays, denials, or changes in benefit status. Benefit notices must comply with specific content...
Body Part Code
A numerical code used in the workers' compensation system to identify the specific body part or organ affected by a work injury. Body part codes are used in claims filing, medical reporting, and...
Bunkhouse Rule
A doctrine that extends workers' compensation coverage to employees who live on the employer's premises, covering injuries that occur in the living quarters during non-work hours.
Burden of Proof
The obligation to prove a disputed fact. In workers' compensation, the injured worker bears the burden of proving that the injury arose out of and in the course of employment, by a preponderance of...
COLA (Cost of Living Adjustment)
Annual adjustments to workers' compensation benefit rates to account for inflation. California's minimum and maximum TD and PD rates are adjusted annually based on the state average weekly wage.
Cal/OSHA
The California Division of Occupational Safety and Health, which enforces workplace safety regulations in California. Cal/OSHA investigates workplace accidents, conducts inspections, and issues...
Case-in-Chief
The main body of evidence presented by a party at trial. In workers' compensation, the applicant's case-in-chief typically includes medical reports, testimony, and documentation of lost wages.
Causation
The medical-legal determination of whether an injury or condition was caused by employment. Causation must be established to a reasonable degree of medical probability (more likely than not) for a...
Certified Interpreter
A language interpreter certified by the DWC to assist injured workers who do not speak English in workers' compensation proceedings, medical appointments, and depositions.
Claims Administrator
The entity responsible for managing a workers' compensation claim on behalf of the employer. This may be an insurance company, a third-party administrator (TPA), or a self-insured employer's claims...
Collateral Source Rule
A legal doctrine that prevents a defendant from reducing damages by the amount of compensation the plaintiff received from other sources (such as health insurance or disability benefits). California...
Commutation
The conversion of future periodic disability payments into a present-value lump sum. Workers can petition the WCAB to commute remaining permanent disability payments when it serves their best...
Comparative Fault
California's system for allocating fault among multiple parties in a personal injury case. Under pure comparative fault, a plaintiff's recovery is reduced by their percentage of fault but is not...
Compromise and Release (C&R)
A lump-sum settlement closing out a workers' compensation claim, including future medical care. It is not valid until a judge approves it.
Compromise and Release with Addendum
A C&R settlement that includes an addendum addressing Medicare Set-Aside obligations, ensuring compliance with CMS requirements for Medicare beneficiaries.
Concurrent Employment
When an injured worker holds multiple jobs at the time of injury. All concurrent employment earnings are considered when calculating the average weekly wage for disability benefits.
Consequential Injury
A new injury that develops as a direct consequence of a compensable work injury. For example, a knee injury caused by altered gait from a compensable back injury is a consequential injury and is also...
Contingency Fee
A fee arrangement where the attorney's payment is contingent upon recovering compensation for the client. In California, workers' compensation attorney fees are set by the WCAB (typically 12-15%),...
Continuing Jurisdiction
The WCAB's ongoing authority over a workers' compensation case even after a final award has been issued. This allows the case to be reopened for new and further disability within five years.
Contra Costa
One of the WCAB district offices serving Contra Costa County workers' compensation cases. District offices are located throughout California to provide local access to the workers' compensation court...
Conversion Disorder
A psychiatric condition where psychological stress manifests as physical symptoms (such as paralysis or blindness) without an organic medical cause. May be compensable as a psychiatric injury in...
Credit/Offset
The workers' compensation insurer's right to be reimbursed from a third-party recovery for benefits already paid to the injured worker. The insurer has a lien against the third-party settlement or...
Cross-Examination
The questioning of a witness by the opposing party during a workers' compensation hearing or deposition. Cross-examination is used to challenge the credibility and accuracy of testimony.
Cumulative Trauma (CT)
A work injury caused by repetitive physically traumatic activities extending over a period of time, the combined effect of which causes disability. Common examples include carpal tunnel syndrome from...
DWC
The Division of Workers' Compensation is the state agency within the California Department of Industrial Relations that administers the workers' compensation system. The DWC oversees medical treatment...
DWC-1 (Workers' Compensation Claim Form)
The form that starts a California workers' compensation claim. The employer must hand it over within one working day of learning about the injury.
Damages
The monetary compensation awarded to an injured person in a personal injury case. Damages may include economic damages (medical bills, lost wages), non-economic damages (pain and suffering), and in...
Date of Injury (DOI)
For a sudden injury, the date the incident happened. For cumulative trauma, the date disability began and the worker knew it was work related.
Date of Knowledge
The date on which the employer first learned or should have learned about a work injury. This date triggers various deadlines including the obligation to provide the DWC-1 form and investigate the...
Death Benefits
Workers' compensation benefits paid to the dependents of a worker who dies as a result of a work-related injury or illness. Benefits include burial expenses (up to $10,000) and weekly payments to...
Declaration of Readiness (DOR)
A document filed with the WCAB requesting that a case be set for hearing. Either party can file a DOR when they believe the case is ready to be heard by a workers' compensation judge.
Defendant
In workers' compensation proceedings, the defendant is typically the employer and/or their workers' compensation insurance carrier who is responsible for providing benefits to the injured worker.
Delay Letter
A notice from the claims administrator that they need additional time (up to 90 days from the date of knowledge) to investigate the claim before accepting or denying it. During the delay period, the...
Demand Letter
A written demand for settlement sent before suit. Common in third-party personal injury claims arising from a work injury.
Denied Claim
A workers' compensation claim that the insurance carrier has rejected, asserting that the injury or illness is not compensable. Common reasons for denial include disputes over causation, late...
Dependency Claim
A claim for death benefits filed by persons who were financially dependent on a worker who died from a work-related injury. Total dependents receive higher benefits than partial dependents.
Deposition
Sworn testimony given by a witness outside of court, recorded by a court reporter. Depositions are a key discovery tool in personal injury cases and can be used at trial if the witness is unavailable.
Depositions in Workers' Compensation
Sworn testimony taken outside of court in a workers' compensation case. Depositions of treating physicians, QMEs, AMEs, and parties are common and their transcripts become evidence in WCAB...
Diminished Future Earning Capacity (DFEC)
A permanent disability adjustment that applies only to injuries before January 1, 2013. A flat 1.4 factor replaced it under Labor Code section 4660.1.
Disability
The gap between what a person can do and what they need to do for work and daily activities. In workers' compensation, disability is distinct from impairment — it considers the impact of impairment on...
Discovery
The pre-trial process of gathering evidence in a legal case. In workers' compensation, discovery includes depositions, interrogatories, requests for production of documents, and subpoenas.
Discrimination (Labor Code §132a)
It is illegal for an employer to discriminate against an employee for filing or intending to file a workers' compensation claim. Remedies include reinstatement, back pay, and increased compensation of...
Dual Capacity Doctrine
A legal theory that allows an employee to sue their employer in civil court (outside workers' compensation) when the employer acts in a capacity other than as an employer, such as a product...
Dual Purpose Doctrine
An exception to the going and coming rule that applies when a trip serves both a personal and business purpose. If the trip would have been made regardless of the personal purpose, the injury may be...
Electronic Adjudication Management System (EAMS)
The Division of Workers' Compensation's electronic case management system for filing documents and tracking California workers' compensation cases.
Employee
A person who performs services for another under a contract of hire, subject to the other's control. In California, the ABC test (from Dynamex) is used to determine employee vs. independent contractor...
Employer's Report of Injury (Form 5020)
The form that employers must file with their workers' compensation insurance carrier within five days of learning about a work injury or occupational illness.
Ergonomic Evaluation
An assessment of a worker's workstation and job tasks to identify risk factors for musculoskeletal injuries. Ergonomic evaluations are often recommended as part of a return-to-work plan.
Ergonomics
The science of designing workplaces, equipment, and tasks to fit the worker's physical capabilities and limitations. Proper ergonomics can prevent cumulative trauma injuries such as carpal tunnel...
Exacerbation
A temporary worsening of a pre-existing condition due to work activity. Unlike aggravation (which implies permanent worsening), an exacerbation is a temporary flare-up that resolves with treatment.
Expedited Hearing
A fast-tracked hearing at the WCAB for urgent issues such as medical treatment disputes, temporary disability payment disputes, or discrimination claims. Expedited hearings are set within 30 days of...
Experience Modification Rate (X-Mod)
A multiplier applied to an employer's workers' compensation insurance premium based on their claims history compared to similar employers. A higher X-Mod means higher premiums due to more frequent or...
Fee Schedule
The Official Medical Fee Schedule (OMFS) established by the DWC that sets maximum reimbursement rates for medical treatment provided to injured workers. Providers cannot bill above the fee schedule.
Findings and Award
The judge's written decision resolving the disputed issues and stating what benefits are owed. Due within 30 days of submission.
Fraud (Workers' Compensation)
Intentional misrepresentation in connection with a workers' compensation claim. Fraud can be committed by employees (faking injuries), employers (underreporting payroll), or medical providers (billing...
Functional Capacity Evaluation (FCE)
A comprehensive assessment of a worker's physical abilities and limitations, typically performed by a physical therapist. FCEs measure lifting capacity, endurance, range of motion, and ability to...
Future Earning Capacity (FEC)
A permanent disability adjustment that applies only to injuries before January 1, 2013. A flat 1.4 factor replaced it under Labor Code section 4660.1.
Future Medical Treatment
Ongoing medical care that an injured worker is entitled to receive for the remainder of their life to cure or relieve the effects of a work injury. This right cannot be waived in a Stipulation...
Going and Coming Rule
A general rule that injuries sustained while commuting to and from work are not compensable under workers' compensation. However, numerous exceptions exist, including the special mission doctrine,...
Good Faith Personnel Action
A defense to psychiatric injury claims asserting that the employer's actions were lawful, nondiscriminatory, and taken in good faith. If the psychiatric injury was substantially caused by a good faith...
Hearing Loss (Industrial)
Occupational hearing loss caused by prolonged exposure to excessive noise levels in the workplace. Industrial hearing loss is a compensable cumulative trauma injury in workers' compensation.
Hearing Representative
A non-attorney representative who assists an injured worker at WCAB hearings. While attorneys are preferred, hearing representatives can provide limited assistance in workers' compensation...
Horseplay
Recreational or playful activity by employees during work hours. Minor horseplay that does not substantially deviate from employment duties may still be covered by workers' compensation.
IMR (Independent Medical Review)
The process for challenging a utilization review denial. An independent physician decides whether the treatment is medically necessary.
Impairment
A loss or abnormality of body structure or function, including mental function. In workers' compensation, impairment is measured using the AMA Guides and expressed as a Whole Person Impairment (WPI)...
Impairment Rating
The percentage of whole person impairment assigned by a physician using the AMA Guides. This rating is the starting point for calculating the permanent disability rating.
Impairment Standard
The medical criteria used to evaluate and quantify permanent impairment. California uses the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, as the impairment standard for injuries...
Indemnity Benefits
Monetary compensation paid to injured workers for lost wages and permanent disability, as distinguished from medical treatment benefits. Indemnity benefits include temporary disability, permanent...
Independent Contractor
A worker outside workers' compensation coverage. The ABC test at Labor Code section 2775 applies to injuries on or after July 1, 2020; earlier injuries and construction subcontracts run on Borello.
Independent Medical Examination (IME)
A medical evaluation performed by a physician who is not the treating doctor, typically at the request of the insurance carrier. In California workers' compensation, the equivalent is the QME or AME...
Industrial Injury
Any injury or illness that arises out of and occurs in the course of employment. This encompasses both specific injuries (single incidents) and cumulative trauma injuries (repetitive stress over...
Informal Rating
A permanent disability rating calculated by the DEU (Disability Evaluation Unit) based on medical reports, without a formal hearing. Informal ratings are advisory and can be disputed.
Injury AOE/COE
An injury that both Arises Out of Employment (AOE) and occurs in the Course of Employment (COE). Both elements must be present for a workers' compensation claim to be compensable.
Injury Prevention Program (IPP)
A written workplace safety program required of all California employers. The IPP must include procedures for identifying hazards, correcting unsafe conditions, training employees, and documenting...
Interim Order
A temporary order issued by a workers' compensation judge pending a final decision. Interim orders may address issues such as medical treatment authorization or temporary disability payments.
Interrogatories
Written questions sent by one party to another during the discovery phase of a lawsuit, which must be answered under oath. Interrogatories are used to gather information about the opposing party's...
Job Analysis
A detailed description of the physical and mental demands of a specific job, used to determine whether an injured worker can return to their usual occupation or requires modified duty.
Joinder
The addition of a party to an existing workers' compensation case. Common examples include joining a subsequent employer when a cumulative trauma claim spans multiple employers.
Judicial Notice
The court's acceptance of certain facts as true without requiring formal proof. In workers' compensation, judges may take judicial notice of medical treatises, government records, and other...
Labor Code Section 132a
Prohibits employer discrimination against workers who file or intend to file workers' compensation claims. Remedies include reinstatement, back pay, costs, expenses, and increased compensation up to...
Labor Code Section 3208.3
Governs psychiatric injury claims in workers' compensation. Requires that the injury be predominantly (51%+) caused by actual events of employment, with additional requirements for claims involving...
Labor Code Section 4660.1
Establishes the use of the AMA Guides (5th Edition) for rating permanent disability in California workers' compensation cases filed on or after January 1, 2005.
Labor Code Section 4850
Provides full salary continuation (in lieu of temporary disability) for up to one year to certain public safety officers (police, firefighters, sheriffs) who are injured in the line of duty.
Labor Code Section 5814
The discretionary penalty for unreasonably delayed or refused compensation: up to 25 percent of the amount delayed or $10,000, whichever is less.
Labor Code Section 5814.5
Requires reasonable attorney fees incurred in enforcing payment when compensation is unreasonably delayed after an award, on top of the section 5814 increase.
Lien
A claim filed against a workers' compensation case by a medical provider, attorney, or other entity seeking payment for services rendered to the injured worker. Liens must be resolved before a case...
Lien Claimant
A medical provider, attorney, or other entity that has filed a lien against a workers' compensation case seeking payment for services rendered to the injured worker.
Life Pension
A weekly benefit paid for life to workers with permanent disability ratings of 70% or higher. The life pension amount is calculated based on the disability rating percentage and the worker's age at...
Light Duty
Temporary work assignments with reduced physical demands that accommodate an injured worker's medical restrictions during recovery. Light duty typically involves less lifting, standing, or repetitive...
Loss of Consortium
A claim by the spouse of an injured person for the loss of companionship, affection, sexual relations, and household services resulting from the injury. Loss of consortium is a derivative claim that...
MMI (Maximum Medical Improvement)
The point at which a worker's condition has stabilized and will not substantially improve. Called 'permanent and stationary' in California.
Mandatory Settlement Conference (MSC)
A settlement hearing before a workers' compensation judge. Discovery closes on the MSC date under Labor Code section 5502(d)(3).
Medi-Cal
California's Medicaid program that provides health coverage to low-income individuals. Medi-Cal may have a lien against a workers' compensation settlement for medical treatment it provided for the...
Mediation
A voluntary dispute resolution process where a neutral third party helps the parties reach a settlement agreement. Mediation is commonly used in personal injury cases before trial and is non-binding...
Medical Payments Coverage (MedPay)
Auto insurance coverage that pays for medical expenses resulting from a car accident regardless of fault. MedPay is optional in California and typically has limits of $1,000 to $10,000.
Medical Provider Network (MPN)
A group of physicians and other healthcare providers approved by the DWC to treat injured workers. Employers or insurers establish MPNs, and injured workers generally must treat within the MPN after...
Medical Treatment Guidelines (MTG)
Evidence-based treatment protocols adopted by the DWC that define the appropriate medical care for work injuries. Based on the ACOEM (American College of Occupational and Environmental Medicine)...
Medical Treatment Utilization Schedule (MTUS)
The evidence-based treatment guidelines adopted by the DWC that establish the presumptively correct standard of care for work injuries. Based on ACOEM guidelines with California-specific...
Medical-Legal Evaluation
A comprehensive medical examination performed by a QME or AME to address disputed medical issues in a workers' compensation case, such as causation, extent of disability, need for future medical...
Medical-Legal Fee Schedule
The DWC fee schedule that sets maximum reimbursement rates for medical-legal evaluations (QME and AME reports) in workers' compensation cases.
Medicare Set-Aside (MSA)
A portion of a workers' compensation settlement allocated to pay for future medical treatment that would otherwise be covered by Medicare. Required when the injured worker is a Medicare beneficiary or...
Mitigation of Damages
The legal duty of an injured person to take reasonable steps to minimize their losses after an injury. Failure to mitigate (such as refusing recommended medical treatment) may reduce the damages...
Modified Duty
Temporary or permanent work assignments that accommodate an injured worker's medical restrictions. Employers are required to offer modified duty when available, and failure to do so may entitle the...
Negligence
The failure to exercise the degree of care that a reasonably prudent person would exercise under similar circumstances. In personal injury law, negligence is the most common basis for liability.
Notice of Denial
A formal letter from the claims administrator informing the injured worker that their workers' compensation claim has been denied, either in whole or in part. The denial must state the specific...
Notice of Offer of Modified or Alternative Work
A formal written offer from the employer to the injured worker providing modified or alternative work that accommodates their medical restrictions. This notice affects the worker's eligibility for...
OSHA
Federal workplace safety law. California runs its own approved program, Cal/OSHA, which covers most employers in the state.
Occupational Disease
An illness or condition that develops as a result of workplace exposures over time, such as asbestosis, carpal tunnel syndrome, or hearing loss. Occupational diseases are compensable under workers'...
Occupational Safety and Health Standards Board
The California state board that adopts workplace safety and health standards (Title 8, California Code of Regulations). These standards are enforced by Cal/OSHA.
Occupational Variant
An adjustment to the permanent disability rating based on the injured worker's occupation at the time of injury. Certain impairments have greater impact on workers in specific occupations.
PR-2 (Primary Treating Physician's Progress Report)
A periodic report submitted by the treating physician to the claims administrator documenting the injured worker's medical status, treatment provided, work restrictions, and expected recovery...
PR-4 (Primary Treating Physician's Permanent and Stationary Report)
The final medical report issued by the treating physician when the injured worker's condition has reached maximum medical improvement. This report includes impairment ratings and forms the basis for...
Pain and Suffering
Non-economic damages awarded to compensate an injured person for physical pain, emotional distress, loss of enjoyment of life, and other subjective harms resulting from an injury. There is no cap on...
Panel QME
A list of three Qualified Medical Evaluators provided by the DWC Medical Unit from which an unrepresented injured worker selects one to perform a medical-legal evaluation.
Penalty
Additional compensation for late or unreasonably withheld benefits: an automatic 10 percent under section 4650(d), and a discretionary penalty of up to 25 percent or $10,000 under section 5814.
Permanent Disability (PD)
Benefits paid to compensate an injured worker for permanent loss of function or earning capacity resulting from a work injury. PD is rated on a scale of 0-100% using the AMA Guides to the Evaluation...
Permanent Disability Advance
An early payment of permanent disability benefits before the final rating is determined. Advances are sometimes paid as part of a settlement negotiation or ordered by the WCAB.
Permanent Disability Rating
The percentage assigned to permanent impairment that sets permanent disability benefits. Labor Code section 4660 governs pre-2013 injuries and section 4660.1 governs 2013 onward.
Permanent Disability Rating Schedule (PDRS)
The schedule converting medical impairment into permanent disability percentages. Labor Code section 4660 governs pre-2013 injuries and section 4660.1 governs 2013 onward.
Permanent Partial Disability (PPD)
A permanent disability rating between 1% and 99%, indicating the worker has some permanent loss of function but is not totally disabled. Benefits are paid based on the percentage rating, with higher...
Permanent Total Disability (PTD)
A 100% permanent disability rating, meaning the injured worker is permanently unable to engage in any substantial gainful employment. PTD entitles the worker to lifetime benefits at the TD rate.
Permanent and Stationary (P&S)
The point at which an injured worker's condition has reached maximum medical improvement (MMI) — meaning it is not expected to substantially improve or worsen with further medical treatment. At P&S...
Petition for Commutation
A formal request to the WCAB to convert remaining periodic permanent disability payments into a present-value lump sum. Commutation is granted when it is in the best interests of the injured worker.
Petition for Reconsideration
An appeal filed with the WCAB commissioners challenging a workers' compensation judge's decision. Must be filed within 20 days of the decision and is decided by a panel of WCAB commissioners.
Petition to Reopen
A formal request to the WCAB to reopen a previously closed workers' compensation case due to new and further disability. Must be filed within five years of the date of injury.
Post-Termination Claim
A workers' compensation claim filed after the employment relationship has ended. Workers have the right to file claims for injuries that occurred during employment even after being terminated or...
Premises Liability
The legal responsibility of property owners and occupiers to maintain safe conditions for visitors. Liability depends on the visitor's status (invitee, licensee, or trespasser) and the foreseeability...
Preponderance of Evidence
The standard of proof in workers' compensation cases, meaning 'more likely than not' or greater than 50% probability. This is a lower standard than 'beyond a reasonable doubt' used in criminal cases.
Presumption of Compensability
Certain workers (firefighters, peace officers, healthcare workers) benefit from legal presumptions that specific injuries or illnesses are work-related, shifting the burden of proof to the employer to...
Product Liability
A claim against the maker or seller of a defective product. California applies strict liability, so proving negligence is not required.
Prognosis
A medical opinion about the expected course and outcome of an injury or illness. In workers' compensation, prognosis affects determinations about temporary disability duration, need for future...
Prophylactic Work Restriction
A medical restriction imposed to prevent future injury rather than to accommodate a current limitation. Prophylactic restrictions may affect permanent disability ratings.
Psychiatric Injury Claim
A workers' compensation claim for mental health conditions caused by employment. California imposes additional requirements: the worker must have been employed for at least six months, and the injury...
Punitive Damages
Damages awarded to punish a defendant for particularly egregious, malicious, or fraudulent conduct and to deter similar behavior. Punitive damages are rare in personal injury cases and require clear...
QME (Qualified Medical Evaluator)
A DWC-certified physician who evaluates disputed medical issues. Used in unrepresented cases, where the worker picks one from a panel of three.
QME Form 105 (Request for QME Panel)
The form filed with the DWC Medical Unit to request a panel of three Qualified Medical Evaluators. Used in unrepresented cases when there is a dispute over medical issues.
QME Form 106 (Request for QME Replacement)
The form used to request a replacement QME when the originally assigned evaluator is unavailable or when there are grounds for disqualification.
Qualified Injured Worker (QIW)
A status under California's repealed vocational rehabilitation system. A supplemental job displacement voucher replaced it, tiered under section 4658.5 for 2004 to 2012 injuries and flat at $6,000 under section 4658.7 from 2013.
Radiculopathy
A condition caused by compression or irritation of a nerve root in the spine, resulting in pain, numbness, tingling, or weakness that radiates along the path of the affected nerve. Common in workers'...
Range of Motion (ROM)
The measurement of movement around a joint, expressed in degrees. ROM deficits are a key factor in determining permanent impairment ratings under the AMA Guides for musculoskeletal injuries.
Rating String
The standardized notation showing how a permanent disability rating was calculated. Its adjustments differ before and after the January 1, 2013 boundary.
Reasonable Medical Treatment
Medical care that is reasonably required to cure or relieve the effects of a work injury. The standard for reasonableness is based on evidence-based medicine and the Medical Treatment Guidelines.
Rehabilitation Maintenance Allowance (RMA)
A weekly payment made to injured workers participating in vocational rehabilitation programs. While the formal VR program ended in 2004, RMA-like payments may be available in certain circumstances.
Reopening a Claim
The process of requesting additional benefits on a previously settled or adjudicated workers' compensation claim due to new and further disability. A petition to reopen must be filed within five years...
Return-to-Work Supplement Program
A state-funded program that provides a one-time supplemental payment of $5,000 to eligible injured workers whose permanent disability benefits are disproportionately low compared to their loss of...
Safety Order Violation
A violation of Cal/OSHA safety regulations by an employer. If a safety order violation contributed to a work injury, the injured worker may receive a 50% increase in compensation under Labor Code...
Self-Insured Employer
An employer that has obtained a certificate from the DIR to self-insure for workers' compensation liability rather than purchasing insurance from a carrier. Self-insured employers must demonstrate...
Self-Procured Medical Treatment
Medical treatment obtained by an injured worker outside the employer's Medical Provider Network. Self-procured treatment may be reimbursable if the MPN was not properly established or the worker was...
Serious Injury
In the context of Cal/OSHA reporting, a work injury that results in hospitalization for more than 24 hours (not just observation), amputation, loss of an eye, or other serious permanent disfigurement.
Serious and Willful Misconduct
When an employer knowingly violates a safety rule or ignores a known hazard, the injured worker may receive a 50% increase in compensation.
Serious and Willful Misconduct (Employee)
A 50 percent reduction in compensation for an employee's own serious and willful misconduct, subject to four statutory exceptions under Labor Code section 4551.
Special Mission Doctrine
An exception to the going and coming rule that provides coverage when an employee is injured while performing a special task or errand for the employer outside of normal work duties or hours.
Specific Injury
A work injury that occurs as the result of one incident or exposure during a single work shift. Examples include falling from a ladder, being struck by equipment, or a single traumatic event.
State Compensation Insurance Fund (SCIF)
California's state-run workers' compensation insurance carrier that serves as the insurer of last resort. SCIF provides coverage to employers who cannot obtain insurance in the private market.
Statute of Limitations
The time limit within which a workers' compensation claim must be filed. In California, the general statute is one year from the date of injury, but for cumulative trauma injuries, it runs from the...
Statute of Limitations (Personal Injury)
In California, the general statute of limitations for personal injury claims is two years from the date of injury. For medical malpractice, it is one year from discovery or three years from the date...
Stipulation with Request for Award (Stip)
A settlement agreement where both parties agree on the terms and submit them to a WCAB judge for approval.
Stipulations with Request for Award (Stip)
A settlement agreement where both parties agree on the level of permanent disability and the injured worker retains the right to future medical treatment. The WCAB issues an Award based on the...
Strict Liability
A legal doctrine that holds a defendant liable for injuries caused by their product or activity regardless of fault or negligence. In California, strict liability applies to manufacturers of defective...
Structured Settlement
A settlement arrangement where the injured worker receives periodic payments over time rather than a single lump sum. Often used in large settlements to provide tax advantages and long-term financial...
Subrogation
The right of a workers' compensation insurance carrier to recover benefits paid to an injured worker from a third party who caused the injury. If a third party (not the employer) is responsible for...
Subsequent Injuries Benefits Trust Fund (SIBTF)
A state fund that provides additional permanent disability benefits to workers who suffer a subsequent industrial injury that, combined with a pre-existing disability, results in a combined disability...
Supplemental Job Displacement Benefit (SJDB)
A voucher of up to $6,000 for retraining, owed unless the employer offers work lasting at least 12 months within 60 days of receiving the first permanent and stationary report.
Supplemental Report
An additional medical report submitted by the treating physician or evaluating physician to address new developments, respond to questions, or provide updated opinions on disputed medical issues.
Survival Action
A claim brought on behalf of a deceased person's estate for damages the decedent suffered before death, including pain and suffering, medical expenses, and lost earnings from the time of injury to...
Temporary Disability (TD)
Wage replacement while an injured worker recovers. Temporary total disability pays two thirds of average weekly earnings.
Temporary Disability Advances
Early payments of temporary disability benefits made before the claim is formally accepted. Claims administrators must provide TD advances within 14 days of knowledge of injury if liability is not...
Temporary Partial Disability (TPD)
Benefits paid when an injured worker can return to modified or light-duty work but earns less than their pre-injury wages. TPD pays two-thirds of the difference between pre-injury wages and current...
Temporary Total Disability (TTD)
Benefits paid when an injured worker is completely unable to work during the recovery period. TTD is calculated at two-thirds of the average weekly wage, with a current maximum of $1,619.15 per week...
Third-Party Administrator (TPA)
A company hired by self-insured employers or insurance carriers to manage workers' compensation claims, including processing paperwork, authorizing treatment, and paying benefits.
Third-Party Claim
A personal injury lawsuit filed against a party other than the employer who caused or contributed to a work injury. Common third-party defendants include equipment manufacturers, property owners, and...
Total Temporary Disability Cap
The maximum duration of temporary total disability benefits in California, which is 104 compensable weeks within a five-year period from the date of injury (with exceptions for certain severe...
Treating Physician's Presumption
The legal presumption that the treating physician's opinion on medical issues is correct, which can be rebutted by the opinion of a QME or AME. This presumption applies in certain circumstances.
Treating Physician's Report
Medical reports submitted by the primary treating physician documenting the injured worker's condition, treatment, work status, and progress. These reports are critical evidence in workers'...
Trial
A formal hearing before a workers' compensation judge where disputed issues are decided based on evidence and testimony. Trials in workers' compensation are less formal than civil court trials but...
Underinsured Motorist Coverage (UIM)
Auto insurance coverage that pays the difference between the at-fault driver's liability limits and the injured person's actual damages when the at-fault driver's coverage is insufficient.
Uninsured Employers Benefits Trust Fund (UEBTF)
A state fund that pays workers' compensation benefits to employees injured while working for illegally uninsured employers. The UEBTF then seeks reimbursement from the uninsured employer.
Uninsured Motorist Coverage (UM)
Auto insurance coverage that pays for injuries caused by a driver who has no liability insurance. In California, insurers must offer UM coverage, and it can be crucial for personal injury claims...
Unreasonable Delay or Denial
When a claims administrator delays or denies workers' compensation benefits without a reasonable basis. Unreasonable delay triggers penalty provisions under Labor Code §5814.
Utilization Review (UR)
The mandatory review in which the claims administrator approves or denies a treating physician's request for medical treatment.
Utilization Review Timeline
Utilization review deadlines: five business days for prospective and concurrent review, 14 days outside, 72 hours for expedited review, and 30 days for retrospective review.
Venue
The geographic location where a workers' compensation case is heard. Generally, venue is proper in the district where the injury occurred, where the employee resides, or where the employer's principal...
Vocational Expert
A professional who assesses an injured worker's ability to return to work and may testify at WCAB hearings on loss of future earning capacity.
Vocational Rehabilitation
Services provided to help injured workers return to suitable employment, including vocational testing, counseling, job placement assistance, and retraining. While the formal VR program was eliminated...
WCAB
The Workers' Compensation Appeals Board is a California state agency that adjudicates disputes between injured workers and employers/insurance carriers. The WCAB has exclusive jurisdiction over...
WCAB Form 1 (Application for Adjudication)
The form filed with the WCAB to open a case. Filing it preserves the injured worker's legal rights and starts formal dispute resolution.
Waiting Period
The three-day waiting period before temporary disability benefits begin. If the disability extends beyond 14 days, the waiting period is retroactively eliminated and benefits are paid from day one.
Walk-Through Settlement
An expedited settlement process where both parties present a fully agreed-upon settlement to a workers' compensation judge for immediate approval, bypassing the normal hearing calendar.
Whole Person Impairment (WPI)
A percentage representing the degree of permanent physical or mental impairment as determined by the AMA Guides. WPI is the starting point for calculating the permanent disability rating in...
Witt v. Jackson Formula
The California Supreme Court formula for allocating a third-party recovery between the injured worker and the workers' compensation insurer, ensuring the worker receives a fair share after attorney...
Work Capacity Evaluation
A comprehensive assessment of an injured worker's ability to perform specific job functions, including lifting, carrying, standing, walking, and other physical demands relevant to their occupation.
Work Hardening
A structured rehabilitation program designed to restore an injured worker's physical capacity to return to work. Work hardening programs simulate actual job tasks and progressively increase demands.
Work Restrictions
Limitations placed on an injured worker's activities by their treating physician, specifying what tasks they can and cannot perform. Common restrictions include lifting limits, no repetitive motions,...
Workers' Compensation
A state-mandated insurance system that provides medical treatment, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits, and death benefits to employees...
Workers' Compensation Insurance
A type of insurance that employers are required to carry in California to cover medical treatment, disability benefits, and other costs associated with work-related injuries and illnesses. It is a...
Workers' Compensation Judge (WCJ)
A judicial officer who presides over workers' compensation hearings, conducts trials, approves settlements, and issues decisions on disputed claims. WCJs are appointed by the WCAB.
Wrap-Up Insurance
A consolidated insurance program that provides workers' compensation and general liability coverage for all contractors and subcontractors on a large construction project under a single policy.
Writ of Review
An appeal to the California Court of Appeal challenging a WCAB decision. This is the next level of appeal after the WCAB denies a Petition for Reconsideration.
Wrongful Death
A civil action brought by the surviving family members of a person who died due to another party's negligence or wrongful act. Damages include loss of financial support, loss of companionship, and...