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Workers' Comp Glossary

Plain-language definitions for the 100 most common workers' compensation terms — claim types, medical evaluations, disability ratings, settlement structures, and the procedural rules that shape every California claim.

Acronyms

AME (Agreed Medical Evaluator): A doctor jointly chosen by both the injured worker (typically through their attorney) and the insurer to evaluate disputed medical issues. Only available when both sides have legal representation.
MPN (Medical Provider Network): A network of medical providers approved by the insurer to treat injured workers. After the first 30 days, treatment generally must be within the MPN unless the worker pre-designated a personal physician.
PD (Permanent Disability): A residual loss of function — physical or mental — that remains after maximum medical recovery. Rated as a percentage and converted to a benefit amount.
QME (Qualified Medical Evaluator): A doctor certified by the State of California to evaluate disputed medical issues in a workers' comp claim. The QME's report is medical-legal evidence used to settle disputes between the injured worker and the insurer.
TPD (Temporary Partial Disability): Wage-replacement benefits paid when a worker can return to modified or reduced-hours work but is earning less than before the injury.
TTD (Temporary Total Disability): Wage-replacement benefits paid while a worker is temporarily unable to work at all due to a job injury. Rate is two-thirds of average weekly earnings up to a statutory maximum.

Claims Process

90-Day Presumption: If an insurer doesn't accept or deny a claim within 90 days of receiving the DWC-1, the injury is presumed compensable, with limited exceptions.
AOE/COE (Arising Out of and in the Course of Employment): The legal test for whether an injury is compensable. AOE means caused by work; COE means happening while performing work duties. Both must be true for coverage.
COVID-19 Presumption: A presumption — for healthcare workers, first responders, and certain other workers — that COVID-19 contracted at work is compensable.
Cumulative Trauma (CT): An injury caused by repeated workplace exposures over time — repetitive motion, prolonged sitting, lifting — rather than a single accident.
Date of Injury (DOI): The legal date a work injury occurred. For specific injuries, the date of the event. For cumulative trauma, generally the date the worker first knew their disability was work-related.
Delay Letter: A formal notice from the insurer that it is delaying acceptance of the claim while investigating. Must give specific reasons and an expected decision date.
Denial Letter: A formal notice from the insurer explaining why a claim is being denied — citing reasons such as lack of evidence, missed deadlines, or pre-existing condition.
DWC-1 (Workers' Compensation Claim Form): The official form for reporting a workplace injury and claiming benefits. The employer must give the worker a DWC-1 within one working day of being notified of an injury.
DWC-AD 10133.32 (Notice of Offer of Modified or Alternative Work): The formal notice an employer uses to offer modified or alternative work to a worker with permanent disability — required to avoid SJDB voucher liability.
DWC-CA Form 1 (Cumulative Trauma Claim Form): The standard claim form, used for both specific and cumulative trauma injuries. Filing this form preserves the worker's rights.
First Responder Presumption: A legal presumption that certain conditions in firefighters and peace officers — heart, cancer, PTSD — are work-related, shifting the burden to the insurer to prove otherwise.
Good Faith Personnel Action Defense: A defense to psychiatric injury claims that allows employers to avoid liability when the predominant cause of the injury was a good-faith, non-discriminatory personnel action.
Labor Code §5402 — 90-Day Acceptance/Denial Rule: Requires the insurer to accept or deny a claim within 90 days. Failure creates a presumption that the injury is compensable.
Notice of Delay in Determining Liability: A formal notice the insurer sends within 14 days of the claim if it is investigating before accepting or denying. Must specify why.
Post-Termination Defense: A limited defense against injuries reported after the worker is terminated, requiring the worker to show prior knowledge or evidence of the injury.
Psychiatric Injury: A mental health condition — depression, anxiety, PTSD — caused predominantly by employment. Subject to special rules including 6-month employment requirement.
RTW (Return to Work): The status of resuming work after an injury, with full duties, modified duties, or alternative work. Employers receive incentives for offering modified or alternative work.
Self-Insured Employer: An employer authorized by the state to pay workers' comp benefits directly rather than buying insurance. Typically large employers and public agencies.
Serious and Willful Misconduct: A finding that an employer's serious and willful misconduct caused the injury, increasing benefits by 50%. High evidentiary bar.
Specific Injury: An injury caused by a single identifiable event at work. Distinct from cumulative trauma.
Statute of Limitations: The deadline to file a workers' comp claim — generally one year from the date of injury, or one year from the last benefit payment.
Transitional / Modified / Light Duty: Work an employer offers that fits within the worker's medical restrictions during recovery. Refusal of suitable modified work may end TTD.

Medical Care

ACOEM Practice Guidelines: Treatment guidelines from the American College of Occupational and Environmental Medicine. Incorporated into the MTUS as the default medical evidence standard.
FCE (Functional Capacity Evaluation): A standardized series of tests that measure a worker's physical abilities — lifting, bending, walking, gripping — to determine what work they can safely perform.
IMR (Independent Medical Review): An independent review by an outside medical professional that resolves disputes when UR denies or modifies treatment. The IMR decision is binding.
Inpatient/Outpatient Hospital Fee Schedule: Specific OMFS sections setting maximum fees for hospital-based services rendered in workers' comp cases.
Interpreter Services: Workers entitled to interpreter services at medical-legal exams, depositions, and WCAB hearings if they don't speak English fluently. Insurer pays.
Medical Report Objection: A written objection to a treating physician's report, the first step in challenging it and triggering the QME process.
Medical-Legal Evaluation: An examination performed by a QME or AME specifically to resolve a disputed medical issue. Distinct from ordinary treatment; the report is evidence.
Mileage Reimbursement: Workers are reimbursed for travel to and from authorized medical appointments. Rate set by the IRS standard mileage rate.
MMI (Maximum Medical Improvement): The state of recovery at which further treatment will not significantly improve the condition. Synonymous with Permanent and Stationary in California workers' comp.
MTUS (Medical Treatment Utilization Schedule): California's evidence-based medical treatment guidelines. UR decisions must follow MTUS unless the treating physician shows the guidelines don't apply.
Official Medical Fee Schedule (OMFS): California's schedule of maximum reasonable fees for medical services in workers' comp cases. Updated annually.
Permanent and Stationary (P&S): The point at which a work injury has stabilized and is unlikely to improve substantially with further medical treatment — also called maximum medical improvement (MMI).
PR-2 (Primary Treating Physician's Progress Report): Periodic report from the treating physician documenting changes in the worker's condition, treatment plan, and ability to work.
PR-4 (Primary Treating Physician's Permanent and Stationary Report): The treating physician's final report when the worker reaches maximum medical improvement. Establishes permanent impairment, work restrictions, and future medical needs.
Predesignation of Personal Physician: A worker's right to designate their personal doctor — in writing, before any injury — as the treating physician for any future workers' comp claim. Bypasses the MPN.
Primary Treating Physician (PTP): The doctor who has overall responsibility for treating the injured worker, coordinating care, and writing the periodic reports (PR-2) and final report (PR-4).
QME Panel: A list of three randomly assigned QMEs in a chosen specialty, generated by the DWC. The worker (without an attorney) or the parties (with attorneys) select one to perform the evaluation.
UR (Utilization Review): The process by which an insurer reviews a treating physician's request for treatment to decide whether to approve, modify, or deny it based on evidence-based guidelines.

Disability Ratings

100% Permanent Total Disability (PTD): The highest level of permanent disability, finding the worker permanently unable to engage in any gainful work. Triggers lifetime indemnity payments.
AMA Guides (5th Edition): The American Medical Association's standardized method for measuring permanent impairment. California uses the 5th Edition for whole-person impairment ratings.
Apportionment: The legal process of dividing responsibility for a permanent disability between the work injury and other (non-industrial) causes. Reduces the insurer's share of the PD payment.
Average Weekly Earnings (AWE): The wage figure used to calculate temporary disability rates. Includes overtime, bonuses, tips, and the value of room/board provided by the employer.
Consultative Rating: An informal rating performed by the DEU, often used to estimate PD before settlement negotiations.
DEU (Disability Evaluation Unit): A unit within the DWC that calculates permanent disability ratings from medical reports — without taking sides — used as evidence in disputed cases.
Labor Market Survey: An analysis of available jobs in the worker's geographic area within their physical and educational capabilities. Used in cases where return to work is in dispute.
PDRS (Permanent Disability Rating Schedule): California's official schedule for converting medical impairments into a permanent disability percentage. The 2005 PDRS, based on AMA Guides 5th Ed., is current law.
Return-to-Work Supplement Program (RTWSP): A one-time payment of $5,000 to PD-rated workers who received an SJDB voucher. Funded by employer assessments.
SJDB (Supplemental Job Displacement Benefit): A voucher of up to $6,000 for retraining or education when a worker with permanent disability can't return to their pre-injury job.
Total Temporary Disability Rate: Two-thirds of the worker's average weekly earnings, subject to statutory minimum and maximum rates that adjust annually.
Two-Thirds Rule: The general rule that wage-replacement benefits (TTD, TPD) equal two-thirds of pre-injury average weekly earnings, capped at statutory maximums.
Vocational Rehabilitation (Voc Rehab): Services helping permanently disabled workers train for new jobs they can perform. Largely replaced in California by the Supplemental Job Displacement Benefit voucher.
Whole Person Impairment (WPI): A percentage representing the total reduction in a person's overall ability to function due to a medical impairment. Used as the starting point for PD rating.

Settlement

C&R (Compromise & Release): A lump-sum settlement that closes the claim entirely. The insurer pays an agreed amount in exchange for full release of liability — including future medical care.
Closed-Out Future Medical: When a Compromise & Release closes the claim, future medical care is closed-out — the worker must use other insurance for future treatment of the injury.
Death Benefits: Payments to the surviving dependents of a worker who died from a job injury. Amount varies by number of dependents up to statutory limits.
Future Medical Care: Continued treatment for the work injury after a Stipulated Award. The insurer remains responsible for medically necessary care related to the injury for life.
Life Pension: Lifetime weekly benefits paid to workers with permanent disability ratings of 70%–99%. Continues for the rest of the worker's life.
Medicare Conditional Payments: Payments Medicare may have made for treatment that should have been the insurer's responsibility. Must be repaid before settlement closes.
MSA (Medicare Set-Aside): A portion of a settlement set aside to pay future Medicare-covered medical expenses. Required for claims involving Medicare-eligible workers above CMS thresholds.
Open Future Medical: Under a Stipulated Award, future medical care for the work injury remains the insurer's responsibility for the life of the claim.
Settlement Offer: A formal monetary offer from the insurer to resolve the claim — usually expressed as a Compromise & Release amount or Stipulated Award terms.
SSD/SSDI Coordination: Coordination of workers' comp benefits with Social Security Disability. Combined benefits are capped at 80% of pre-injury earnings.
Stipulated Award (Stip): A settlement that pays out the value of permanent disability over time and keeps future medical care open. Often used when ongoing treatment is expected.
Uninsured Employers Benefits Trust Fund (UEBTF): A state fund that pays benefits to workers whose employers illegally failed to carry workers' comp insurance. The fund then pursues the employer.

Legal Procedure

§5710 Fees: Reasonable attorney fees the worker's attorney can recover when the insurer takes the worker's deposition. Paid by the insurer.
§5814 Penalty: A penalty — up to 25% of the unreasonably delayed benefit — assessed against the insurer for unreasonable delay in providing benefits.
ADA / FEHA Interaction: Workers' comp benefits run separately from rights under the Americans with Disabilities Act and California's FEHA. Reasonable accommodation may be required even after a comp claim ends.
Application for Adjudication of Claim: The formal pleading that opens a case at the WCAB when there is a dispute. Filed via EAMS; assigns a case number.
Burden of Proof: In workers' comp, the worker generally has the burden to prove injury and disability by a preponderance of the evidence (more likely than not).
Certified Workers' Comp Specialist: A California State Bar designation given to attorneys who have demonstrated expertise in workers' comp law through experience, references, and a written exam.
Deposition: Sworn out-of-court testimony given under oath, typically taken by the opposing party's attorney. The injured worker may be deposed regarding their injury, prior medical history, and work duties.
DWC (Division of Workers' Compensation): The state agency that administers the workers' comp system in California, including the WCAB, audits, and information services.
DWC Audit Unit: The DWC unit that audits insurers' compliance with timely payment of benefits and proper claim handling.
EAMS (Electronic Adjudication Management System): The DWC's online filing system for workers' comp documents. Attorneys and parties file petitions, motions, and exhibits through EAMS.
Findings, Award, and Order (F&A): The formal written decision of a WCJ following trial — establishes liability, benefit amounts, and ongoing obligations.
Five-Year Statute (Petition to Reopen): The five-year period from the date of injury during which a claim can be reopened to consider new injury or increased disability.
IBR (Independent Bill Review): An independent process for resolving disputes about the amount paid for medical services rendered to an injured worker.
Labor Code §132a (Anti-Retaliation): Prohibits employers from discriminating or retaliating against workers for filing or pursuing a workers' comp claim. Penalty up to $10,000 plus reinstatement and lost wages.
Lay Witness: A non-expert witness — a coworker, family member, or supervisor — who can testify about facts they personally observed, such as the injury event or the worker's symptoms.
Liberal Construction Rule: California law requires courts to liberally construe workers' comp statutes in favor of injured workers — guidance for resolving close legal questions.
Lien: A claim filed against a workers' comp case by a medical provider, copy service, interpreter, or other party seeking payment for services provided.
Lien Claimant: A medical provider or other party that has filed a lien against the workers' comp case seeking payment.
Medical Expert Witness: A QME, AME, or other physician who testifies about medical causation, diagnosis, treatment, or impairment based on their expert evaluation.
Medical Records Copy Service: A vendor that obtains and copies medical records under workers' comp subpoena. Costs are billed against the case as a lien.
MSC (Mandatory Settlement Conference): A WCAB conference where the parties — with a workers' comp judge facilitating — try to resolve the case without trial. If unresolved, the case is set for trial.
Permanent Stationary Order (Findings & Award): A WCJ's order making findings of fact and awarding specific benefits — typically issued after trial when the parties don't settle.
Petition for Reconsideration: An appeal of a WCJ's decision to a panel of WCAB commissioners. Must be filed within 20 days of the decision.
Petition to Reopen: A petition asking the WCAB to reopen a previously settled or awarded case based on new and changed circumstances. Strict five-year deadline from DOI.
Stipulations: Agreements between the parties about specific facts — date of injury, parts of body injured, average weekly earnings — that don't need to be proven at trial.
Sub Rosa Investigation: Hidden surveillance of an injured worker — videotaping, photographing — used by insurers to challenge the severity of claimed disability. Legal in California with limits.
Subrogation: The insurer's right to recover payments made on the claim from a third party whose negligence caused or contributed to the injury (e.g., a non-employer driver in a work-related auto accident).
Third-Party Claim: A separate civil lawsuit against a non-employer party (a manufacturer, contractor, driver) whose negligence caused a workplace injury. May proceed alongside the workers' comp claim.
WCAB (Workers' Compensation Appeals Board): The administrative court system that hears workers' comp disputes in California. Has trial-level judges (WCJs) and an appellate panel.
WCJ (Workers' Compensation Judge): An administrative law judge who hears workers' comp cases at the WCAB trial level. Issues findings and awards after trial.
Workers' Comp Discrimination: Adverse employment action — termination, demotion, denial of benefits — taken because the worker filed or intends to file a workers' comp claim. Prohibited under §132a.
Workers' Comp Trial: A bench trial — no jury — before a Workers' Comp Judge. Typically includes the worker's testimony, medical records, and live or stipulated medical-legal evidence.
Writ of Review: An appeal of a WCAB en banc or panel decision to the California Court of Appeal. The court may grant or deny review.