Glossary
The terms listed below are common terms used within the work comp system.
Agreed Medical Examiner (AME): A physician selected by your attorney and the claims administrator who conducts a medical evaluation and submits a comprehensive report to the parties.
AOE/COE (Arising out of and/or occurring in the course
of employment):
This means that an industrial injury must be caused by and happen on the job.
Applicant: The party, usually the injured worker, who establishes a case before the Workers' Compensation Appeals Board (WCAB).
Defendant: The employer or his/her representative, usually the insurance company.
Division of Workers' Compensation (DWC): The state agency that oversees the California workers' compensation system.
Fraud: Any knowingly false or fraudulent material statement for the purpose of obtaining or denying workers' compensation benefits.
Future Medical: Ongoing entitlement to medical treatment for a work related injury.
Industrial Medical Council (IMC): The state agency that certifies Qualified Medical Evaluators (QME) and issues Panel QMEs when there is a dispute with the treating doctor's report. (See Panel QME.)
Information & Assistance Unit (I&A): A unit within DWC that provides information to all parties and informally resolves disputes.
Lien: A right or claim for payment against a workers' compensation case.
Medical Treatment: Treatment reasonably required to cure or relieve from the effects of a work-related injury or illness.
Modified Work: A change in your working conditions in order to accommodate permanent work restrictions determined by your Primary Treating Physician when you have become Permanent and Stationary.
Panel Qualified Medical Evaluator: A list of three independent qualified medical evaluators issued by the state Industrial Medical Council. You select any one of the three doctors for your evaluation. This is for workers not represented by an attorney.
Permanent and Stationary (P&S): A term for describing when your medical condition has reached maximum medical improvement.
Permanent Disability (PD): Any residual disability that impairs your ability to compete in the open labor market after you become permanent and stationary.
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.
Pre-designated Physician: A Primary Treating Physician that can initially treat you if you have advised your employer in writing prior to the industrial injury or illness. You must have seen the predesignated physician prior to selection.
Primary Treating Physician (PTP): The doctor who has overall responsibility for treatment of your industrial injury or illness. There can only be one PTP at a time.
Qualified Medical Evaluator (QME): An independent physician certified by the Industrial Medical Council to perform medical evaluations.
Temporary Disability (TD) or Temporary Total Disability (TTD): A wage replacement benefit paid when your physician reports you cannot work because of an industrial injury or illness.
Temporary Partial Disability (TPD): A wage replacement benefit that may be paid when you return to work but at less than full earnings. Sometimes referred to as Wage Loss.
Vocational Rehabilitation: This benefit assists qualified injured workers in returning to work.
Workers' Compensation Appeals Board (WCAB):
The judicial unit that formally resolves workers' compensation disputes.