Glossary of Workers Compensation Terms

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1 Glossary of Workers Compensation Terms A Accepted claim: A claim in which the insurance company agrees that the injured worker s injury or illness is covered by workers' compensation. Even if the claim is accepted there may be delays or other issues to address. Also called admitted claim. Agreed Medical Evaluator (AME): When the injured worker has an attorney, an AME is the doctor the attorney and the insurance company agree on to conduct the medical examination that will help resolve the dispute. Allocated Loss Adjustment Expense (ALAE): Loss adjustment expenses that are assignable or allocable to specific claims. Fees paid to outside attorneys, experts, and investigators used to defend claims are examples of ALAE Alternative Work: A new job with the injured worker s former employer. If the injured worker s doctor says he/she will not be able to return to the job at the time of injury, the employer is encouraged to offer the injured worker alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits the injured worker was paid at the time he/she was injured, and be within a reasonable commuting distance of where he/she lived at the time of injury. American Medical Association (AMA): A national physician's group. The AMA publishes a set of guidelines called "Guides to the Evaluation of Permanent Impairment." If the injured worker s permanent disability is rated under the 2005 rating schedule, the doctor is required to determine the level of impairment using the AMA's guides. Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. If the injured worker believes they've been discriminated against at work because they're disabled and want information on their rights under the ADA, he/she should contact a U.S. Equal Employment Opportunity Commission Page 1 of 20

2 office. For the EEOC office in their local area, call or (TTY). AOE/COE (Arising out of and occurring in the course of employment): The reported injury must be caused by and happen on the job. Applicant: The party that opens a case at the local Workers' Compensation Appeals Board (WCAB) office by filing an application for adjudication of claim. Appeals Board: A group of seven commissioners appointed by the governor to review and reconsider decisions of workers' compensation administrative law judges. Also called the Reconsideration Unit. See Workers' Compensation Appeals Board. Applicants' attorney: A lawyer that can represent the injured worker in their workers' compensation case. Applicant refers to the injured worker. Application for Adjudication of Claim (Application or App): A form filed to open a case at the local Workers' Compensation Appeals Board (WCAB) office if parties have a disagreement about their claim. Apportionment: A way of figuring out how much of the permanent disability is due to the work injury and how much is due to other disabilities. Audit Unit: A unit within the DWC that receives complaints against claims administrators. These complaints may lead to investigations of the way the company handles claims. B Benefit notice: A required letter or form sent to the injured worker by the insurance company to inform the injured worker of the benefits he/she may be entitled to receive. Also called notice. C Cal/OSHA: A unit within the state Division of Occupational Safety and Health (DOSH). Cal/OSHA inspects workplaces and enforces laws to protect the health and safety of workers in California. California Labor Code section 132a: A workers' compensation law that prohibits discrimination against the injured worker because Page 2 of 20

3 he/she filed a workers' compensation claim, and against co-workers who might testify in their case. Carve-out: Carve-out programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement. Centers for Medicare & Medicaid Services (CMS): agency within the US Department of Health & Human Services responsible for administration of several key federal health care programs. In addition to Medicare (the federal health insurance program for seniors) and Medicaid (the federal needs-based program), CMS oversees the Children s Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and the Clinical Laboratory Improvement Amendments (CLIA), among other services. The website is: Claim Form: The form used to report a work injury or illness to the employer. Claims Adjuster: See claims administrator. Claims Administrator: The term for insurance companies and others that handle the workers' compensation claim. Most claims administrators work for insurance companies or third party administrators handling claims for employers. Some claims administrators work directly for large employers that handle their own claims. Also called claims examiner or claims adjuster. Claims Examiner: See claims administrator. Commission on Health and Safety and Workers' Compensation (CHSWC): A state-appointed body that conducts studies and makes recommendations to improve the California workers' compensation and workplace health and safety systems. Commutation: An order by a workers' compensation judge for a lump sum payment of part or the entire permanent disability award. Compromise and Release (C&R): A type of settlement in which the injured worker receives a lump sum payment and become responsible for paying for his/her future medical care. A settlement like this must be approved by a workers' compensation judge. Cumulative injury (CT): An injury that was caused by repeated events or repeated exposures at work. For example, a claimant hurting Page 3 of 20

4 his/her wrist doing the same motion over and over or losing his/her hearing because of constant loud noise. D Date of injury: Date in which injured worker got hurt or ill. If the injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated exposures (a cumulative injury), the date of injury is the date he/she knew or should have known the injury was caused by work. Death Benefits: Benefits paid to surviving dependents when a work injury or illness results in death. Declaration of Readiness (DOR or DR): A form used to request a hearing before a workers' compensation judge when parties are ready to resolve a dispute. Defendant: The party, usually the employer or its insurance company -- opposing a dispute over benefits or services. Delay letter: A letter sent by the insurance company that explains why payments are delayed. The letter also tells what information is needed before payments will be sent and when a decision will be made about the payments. Denied claim: A claim in which the insurance company believes the injury or illness is not covered by workers' compensation and has notified the injured worker of the decision. Description of employee's job duties (RU-91): A form filled out jointly by injured worker and the insurance company that helps the treating physician decide whether the injured worker will be able to return to their normal job and working conditions. Determination and Order (D&O): A decision by the DWC Rehabilitation Unit on a vocational rehabilitation dispute. Disability: A physical or mental impairment that limits life activities. A condition that makes engaging in physical, social and work activities difficult. Disability Evaluation Unit (DEU): A unit within the DWC that calculates the percent of permanent disability based on medical reports. See disability rater. Page 4 of 20

5 Disability management: A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment. This is done early in the recovery process in severe injury cases such as spinal injuries. Usually a rehabilitation nurse is involved with the injured worker and the treating doctor and the progress of the medical treatment is reported to the insurance company. Disability rater: An employee of the DWC Disability Evaluation Unit who rates the permanent disability after reviewing a medical report or a medical-legal report describing the injured workers condition. Disability rating: See permanent disability rating. Discrimination claim (Labor Code132a): A petition filed if the employer has fired or otherwise discriminated against the injured worker for filing a workers' compensation claim. Dispute: A disagreement about the injured workers right to payments, services or other benefits. Division of Workers' Compensation (DWC): A division within the state Department of Industrial Relations (DIR). The DWC administers workers' compensation laws, resolves disputes over workers' compensation benefits and provides information and assistance to injured workers and others about the workers' compensation system. E Electronic Adjudication Management System (EAMS): A computer based system to simplify and improve the Division of Workers Compensation case management process. Electronic Data Interchange (EDI): is the computer-to-computer exchange of data or information in a standardized format. In California workers compensation, medical EDI refers to the electronic transmission of detailed medical bill payment records information from trading partners, i.e. senders, to the California Division of Workers Compensation. Employee: A person whose work activities are under the control of an individual or entity. The term employee includes undocumented workers and minors. Employer: The person or entity with control over an employees work activities. Page 5 of 20

6 Ergonomics: The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work. That means considering the variability in human capabilities when selecting, designing or modifying equipment, tools, work tasks and the work environment. Essential functions: Duties considered crucial to the job a person wants or has. When being considered for alternative work, the injured worker must have both the physical and mental qualifications to fulfill the job's essential functions. Ex parte communication: Generally a private communication with a judge regarding a disputed matter without the other party being present or copied with correspondence. F Fair Employment and Housing Act (FEHA): A state law that prohibits discrimination against people with disabilities. If an injured worker believes they've been discriminated against at work because they're disabled and want more information on their rights under the FEHA, they should contact the State Department of Fair Employment and Housing at In some cases, the FEHA provides more protection than the federal Americans with Disabilities Act (ADA). Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, jobprotected leave per year. It also requires that group health benefits be maintained during the leave. For more information, contact the U.S. Department of Labor at USA-DOL. Filing: Sending or delivering a document to an employer or a government agency as part of a legal process. The date of filing is the date the document is received. Final order: Any order, decision or award made by a workers' compensation judge that has not been appealed in a timely way. Findings & Award (F&A): A written decision by a workers' compensation administrative law judge about the case, including payments and future care that must be provided to the injured worker. The F&A becomes a final order unless appealed. Fraud: Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers' compensation benefits. The penalties for Page 6 of 20

7 committing fraud are fines up to $150,000 and/or imprisonment for up to five years. Future Earning Capacity (FEC): A multiplier that increases the disability rating based on how much wage loss a type of injury causes on average when compared to other types of injuries. Future medical: On-going right to medical treatment for a workrelated injury. H Health Care Organization (HCO): An organization certified by the Department of Industrial Relations to provide managed medical care within the workers' compensation system. Hearings: Legal proceedings in which a workers' compensation judge discusses the issues in a case or receives information in order to make a decision about a dispute or a proposed settlement. I In pro per: An injured worker not represented by an attorney. Incurral(s): Claim(s) that are created/set up in the claim system, when the claims administrator and/or claims adjuster receives knowledge of an alleged or potential injury or condition. Incurred Loss (es): Losses occurring within a fixed period, whether or not adjusted or paid during the same period. Independent Bill Review (IBR): Medical treatment and medicallegal billing disputes will now be resolved through an independent bill review (IBR) process. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill may apply for IBR. IBR applies to any medical service bill where the date of service is on or after Jan. 1, 2013 and where the fee is determined by a fee schedule established by the DWC Independent Contractor: There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor. Some employers misclassify employees as an independent contractor to avoid workers' compensation and other payroll responsibilities. Just because an employer says an employee/person is an independent contractor and doesn't need to cover an injured Page 7 of 20

8 worker under a workers' compensation policy doesn't make it true. A true independent contractor has control over how their work is done. Injured Workers probably are not an independent contractor when the person paying them: Controls the details or manner of the work Has the right to terminate employee/person Pays employee/person worker an hourly wage or salary Makes deductions for unemployment or Social Security Supplies materials or tools Requires employee/person to work specific days or hours Industrial Medical Council (IMC): No longer in existence. See Medical Unit. Independent Medical Examiner (IME): For injuries occurring on and after January 1, 1991, whenever the term "independent medical examiner" is used, the term shall mean "qualified medical examiner." Independent Medical Review (IMR): California s worker s compensation system will use a process called independent medical review (IMR) to resolve disputes about the medical treatment of injured employees. As of July 1, 2013, medical treatment disputes for all dates of injury will be resolved by physicians through an efficient process known as IMR, rather than through the often cumbersome and costly court system. Additional information can be found at: https://www.dir.ca.gov/dwc/imr.htm Independent Medical Review Organization (IMRO): See Maximus Federal Services Inc. Information & Assistance Unit (I&A): A unit within DWC that provides information to all parties in workers' compensation claims and informally resolves disputes. Information & Assistance (I&A) officer: A DWC employee who answers questions, assists injured workers, provides written materials, conducts informational workshops and holds meetings to informally resolve problems with claims. Injury and Illness prevention program (IIPP): A health and safety program employers are required to develop and implement. This program is enforced by Cal/OSHA. Page 8 of 20

9 Injured Worker (IW): employeee who suffer job-related injuries or illnesses. Impairment rating: A percentage estimate of how much normal use of the injured body parts has been lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate the permanent disability rating but is different from the permanent disability rating. J Judge: See workers' compensation administrative law judge. L Lien: A right or claim for payment against a workers' compensation case. A lien injured worker, such as a medical provider, can file a form with the local Workers' Compensation Appeals Board to request payment of money owed in a workers' compensation case. M Mandatory Settlement Conference (MSC): A required conference to discuss settlement prior to a trial. Maximal Medical Improvement (MMI): When the injured workers condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Once MMI is reached, a doctor can assess how much, if any, permanent disability resulted from the work injury. Maximus Federal Services Inc.: The administrative director (AD) has designated Maximus as the Independent Medical Review Organization (IMRO) to conduct all IMR through Dec. 31, Maximus contracts with medical professionals to perform IMR and each medical professional must meet rigorous qualification and conflict of interest standards Mediation Conference: A voluntary conference held before an I&A officer to resolve a dispute if injured worker is not represented by an attorney. Medical care: See medical treatment. Page 9 of 20

10 Medical-Legal Report: A report written by a doctor that describes the injured workers medical condition. These reports are written to help clarify disputed medical issues. Medical Provider Network (MPN): An entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Medical treatment: Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care. Medical Treatment Utilization Schedule (MTUS): Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in the medical treatment utilization schedule (MTUS), which contains a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given, the extent of the treatment, and for how long, among other things. Medical Unit: A unit within the DWC that oversees medical provider networks (MPNs), independent medical review (IMR) physicians, health care organizations (HCOs), qualified medical evaluators (QMEs), panel QMEs, utilization review (UR) plans, and spinal surgery second opinion physicians. Formerly called the Industrial Medical Council (IMC). Medicare Secondary Payer Act (MSP Act): states Medicare benefits are secondary to workers compensation and liability insurance, payments based on legal liability for injury or illness or damage to property, including self-insured plans, automobile liability insurance, uninsured motorist insurance, underinsured motorist insurance, homeowners liability insurance, malpractice insurance, product liability insurance, general casualty insurance, and no-fault insurance. 42 CFR Section Medicare Secondary Payer (MSP): term generally used when the Medicare program does not have primary payment responsibility. Primary payers are those that have the primary responsibility for paying a claim. Medicare Secondary Payer Recovery Contractor (MSPRC): entity that attempts to recover secondary payments made by Page 10 of 20

11 Medicare. Medicare Secondary Payer Act provides the necessary authority to the MSPRC to identify and recover these payments. Medicare Set Aside (MSA): An amount of money related to future medical expenses that must be reserved from an employee benefits, workers compensation, or auto insurance claim settlement that involves a Medicare-eligible injured worker. The purpose of the setaside is to protect Medicare Interest from paying for medical benefits that should have been funded by the party responsible for causing the injury. Although applicable to general liability and automobile no-fault claims, the set-aside is most commonly a factor in workers compensation claim settlements. Modified work: Injured Worker s job at the time of injury, with some changes that allow them to perform it within the documented work restrictions. If the doctor says injured worker will not be able to return to their job at the time of injury, the employer is encouraged to offer modified work instead of supplemental job displacement benefits or vocational rehabilitation benefits. N Nontransferable voucher: A document from the claims administrator that must be completed by both the injured worker and the claims administrator. This is the document used to provide payment for education under the supplemental job displacement benefit program. Notice: See Benefit Notice. O Objective factors: Measurements, direct observations and test results a treating physician, QME or an AME says contribute to the permanent disability. Off calendar (OTOC): A WCAB case in which there is no pending action. Office of Self Insurance Plans (OSIP): a program within the director's office of the Department of Industrial Relations (DIR) responsible for the oversight and regulation of workers compensation self-insurance within California. OSIP is also responsible for establishing and insuring that required security deposits are posted by self-insurers in amounts sufficient to collateralize against potential defaults by self-insured employers and groups. Page 11 of 20

12 Offer of modified or alternative work form (RU-94): A form from the claims administrator if: injured worker was injured before 2004 and; the treating physician says Injured Worker probably will never return to their usual and customary job or one like it and; the employer is offering modified or alternative work instead of vocational rehabilitation benefits. Offer of modified or alternative work (DWC form #AD ): A form from the claims administrator if: the Injured Worker was injured in 2004 or later and; the treating physician reports there is permanent disability and; the employer is offering modified or alternative work instead of a supplemental job displacement benefit. This form also explains how the permanent disability payments may be lowered by 15 percent because the employer is returning the injured worker to work. Order Approving Compromise and Release (OAC&R): Order signed by WCJ approving settlement by way of Compromise and Release. Other Indemnity (OI): Payments issued by claims administrator for costs associated with indemnity benefits other than TD, PD, VMRA or Death Benefits. Examples of these costs are: Applicant Voc-Expert fees, Depositions fees to the Applicant Attorney, Deposition Mileage to Injured Worker and Deposition Court Reporter or Deposition Witness Fees. P Panel Qualified Medical Evaluator (QME): A list of three independent qualified medical evaluators (QMEs) issued by the DWC Medical Unit. Injured Worker may select any one of the three doctors for the evaluation. If the Injured Worker has an attorney, additional/other rules apply. Party: Normally this includes the claims administrator, insurance company, the employer, attorneys and any other person with an interest in the claim (doctors or hospitals that have not been paid). Permanent and Stationary (P&S): When the medical condition has reached maximum medical improvement. Once P&S d, a doctor can assess how much, if any, permanent disability resulted from the work injury. If the disability is rated under the 2005 schedule, the term maximal medical improvement (MMI) is used in place of P&S. See also P&S report. Page 12 of 20

13 Permanent Disability (PD): Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. Permanent Disability Rating (PDR): A percentage that estimates how much a job injury permanently limits the kinds of work the Injured Worker can do. It is based on the medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by the job, and the diminished future earning capacity. It determines the number of weeks Injured Worker is entitled to permanent disability benefits. Permanent Disability Rating Schedule (PDRS): A DWC publication containing detailed information used to rate permanent disabilities. One of three schedules will be used to rate the disability, depending on when the Injured Worker was injured. Permanent Disability (PD) Benefits: Payments the Injured Worker receives when the work injury permanently limits the kinds of work he/she can do or his/her ability to earn a living. Permanent Disability Advance (PDA): A voluntary lump sum payment of permanent disability due in the future. Permanent Disability Payments: A mandatory bi-weekly payment based on the undisputed portion of permanent disability received before and/or after an award is issued. Permanent Partial Disability Award: A final award of permanent partial disability made by a workers' compensation judge or the Workers' Compensation Appeals Board. Permanent Partial Disability (PPD) benefits: Payments received when the work injury partially limits the kinds of work the Injured Worker can do or his/her ability to earn a living. Permanent Total Disability (PTD) benefits: Payments received when Injured Worker is considered permanently unable to earn a living. Penalty: An amount of money received because something wasn't done correctly on the claim. Paid by employer or the claims administrator, the penalty amount can be an automatic 10 percent for a delay in payment to Injured Worker, or a 25 percent penalty -- up to $10, for an unreasonable delay. Page 13 of 20

14 Personal physician: A doctor licensed in California with an M.D. degree (medical doctor) or a D.O. degree (osteopath), who has treated the Injured Worker in the past and has his/her medical records. Petition for Reconsideration (Recon): A legal process to appeal a decision issued by a workers' compensation judge. Heard by the Workers' Compensation Appeals Board Reconsideration Unit, a sevenmember, judicial body appointed by the governor and confirmed by the Senate. Physician: A medical doctor, an osteopath, a psychologist, an acupuncturist, an optometrist, a dentist, a podiatrist or a chiropractor licensed in California. The definition of personal physician is more limited. See personal physician. Predesignated physician: A physician that can treat the work injury if Injured Worker advises the employer in writing prior to the work injury or illness and certain conditions are met. See predesignation. Predesignation: The process used to tell the employer that the Injured Worker wants their personal physician to treat him/her for a work injury. Injured Worker can predesignate his/her personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) if: the employer offers group health coverage; the doctor has treated him/her in the past and has his/her medical records; prior to the injury the doctor agreed to treat him/her for work injuries or illnesses and; prior to the injury employee provided the employer the following in writing: 1. Notice that they want their personal doctor to treat him/her for a work-related injury or illness and 2. The personal doctor's name and business address. Primary treating physician (PTP): The doctor having overall responsibility for treatment of the work injury or illness. This physician writes medical reports that may affect the benefits. Also called treating physician or treating doctor. Proof of Service: A form used to show that documents have been sent to specific parties. P&S report: A medical report written by a treating physician that describes the medical condition when it has stabilized. See also permanent and stationary. Q Page 14 of 20

15 Qualified Injured Worker (QIW): Entitled to vocational rehabilitation benefits. This benefit applies only if they were injured before Jan. 1, Qualified Medical Evaluator (QME): An independent physician certified by the DWC Medical Unit to perform medical evaluations. Qualified Rehabilitation Representative (QRR): A person trained and able to evaluate, counsel, and place disabled workers in new jobs. Also called rehabilitation counselor. R Rating: See permanent disability rating. Reconsideration: See petition for reconsideration. Reconsideration of a summary rating: A process used when Injured Worker does not have an attorney and thinks mistakes were made in their permanent disability rating. Reconsideration Unit: See appeals board. Regular work: The same job the employee was performing at the time of injury, paying the same wages and benefits as paid at the time of an injury and located within a reasonable commuting distance of where the Injured Worker lived at the time of the injury. Rehabilitation consultant: A DWC employee, who oversees vocational rehabilitation procedures, makes decisions about vocational rehabilitation benefits and helps resolve disputes. Rehabilitation counselor: See qualified rehabilitation representative (QRR). Rehabilitation Unit: A unit within DWC that resolves vocational rehabilitation disputes approves potential settlements of vocational rehabilitation services, and reviews and approves vocational rehabilitation plans for injuries that happened before Jan. 1, Restrictions: See work restrictions. S Senate Bill 863 (SB863): Senate Bill passed on Aug. 31, 2012 and was signed into law by Governor Brown on Sept. 18, The bill makes wide-ranging changes to California s workers compensation system, including increased benefits to injured workers and cost- Page 15 of 20

16 saving efficiencies. The bill takes effect on Jan. 1, 2013, although not all of its provisions were effective immediately. Schedule for rating permanent disabilities: See permanent disability rating schedule. Self Imposed Penalty/Self-Imposed Increase (SII): In accordance with Labor Code Section 4650(d), It is the payment issued by the claims administator, if any indemnity payment is not made timely. The late payment shall be increased by 10% and paid to the injured worker directly. See Penalty Self-Insurance Plans (SIP): see Office of Self Insurance Plans above. Settlement: An agreement between Injured Worker and the claims administrator about the workers' compensation payments and future medical care. Settlements must be reviewed by a workers' compensation judge to make sure they are adequate. Serious and Willful Misconduct (S&W): A petition filed if the injury is caused by the serious and willful misconduct of the employer. Social Security Disability (SSD): a payroll tax-funded, federal insurance benefits program of the United States government. It is managed by the Social Security Administration and is designed to provide income supplements to people who are physically restricted in their ability to be employed because of a notable disability, usually a physical disability. SSD can be supplied on either a temporary or permanent basis, usually directly correlated to whether the person's disability is temporary or permanent. These benefits are reduced by workers' compensation payments you receive. Special Investigation Unit (SIU): Unit or department within an insurance company involved in detecting and pursuing action against fraudulent activities on the part of insured s or injured workers. Specific injury: An injury caused by one event at work. Examples: hurting the back in a fall, getting burned by a chemical splashed on the skin, getting hurt in a car accident while making deliveries. State average weekly wage: The average weekly wage paid in the previous year to employees in California covered by unemployment insurance, as reported by the U.S. Department of Labor. Effective 2006, temporary disability benefit increases are tied to this index. Page 16 of 20

17 State disability insurance (SDI): A partial wage-replacement insurance plan paid out to California workers by the state Employment Development Department (EDD). SDI provides short-term benefits to eligible workers who suffer a loss of wages when they are unable to work due to a non-work-related illness or injury, or a medically disabling condition from pregnancy or childbirth. Workers with job injuries may apply for SDI when workers' compensation payments are delayed or denied. Call for more information on SDI. Stipulated rating: Formal agreement on the permanent disability rating. Must be approved by a workers' compensation judge. Stipulation with Award: A settlement of a case where the parties agree on the terms of an award. This is the document the judge signs to make the award final. Stipulations with Request for Award (Stips): A settlement in which the parties agree on the terms of an award. It may include future medical treatment. Payment takes place over time. This document is provided to the judge for final review. Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker's permanent disability. Subjective factors are given very little weight under the 2005 rating schedule as the schedule relies mainly on objective measurements. Subpoena: A document that requires a witness to appear at a hearing. Subpoena Duces Tecum (SDT): A document that requires records be sent to the requester. Summary rating: The percentage of permanent disability calculated by the DWC Disability Evaluation Unit. Summary Rating Reconsideration: A procedure used if you object to the summary rating issued by the DWC Disability Evaluation Unit. Supplemental Job Displacement Benefit (SJDB): A workers' compensation benefit. If Injured Worker was injured in 2004 or later, and has a permanent partial disability that prevents him/her from doing their old job, and the employer does not offer other work, Injured Worker would qualify for this benefit. It is in the form of a voucher that promises to help pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools. Also called voucher. Page 17 of 20

18 T Temporary disability (TD or TTD): Payments issued by claims administrator when Injured Worker loses wages because the injury prevents him/her from doing their usual job while recovering. Temporary Partial Disability (TPD) benefits: Payments issued by claims administrator when Injured Worker can do some work while recovering, but earns less than before the injury which can be due to a reduction in hours or salary, due to a different job. Temporary Total Disability (TTD) benefits: Payments issued by claims administrator when Injured Worker cannot work at all while recovering. Transportation expenses: A benefit to cover the out-of-pocket expenses for mileage, parking and toll fees related to a claim. Usually a reimbursement. Treating doctor: See primary treating physician. Treating physician: See primary treating physician. U Unallocated Loss Adjustment Expense (ULAE): All external, internal, and administrative claims handling expenses, including determination of coverage and penalties, that are not included in allocated loss adjustment expenses (ALAEs). Uninsured Employers Fund (UEF): A fund, run by the DWC, through which the benefits can be paid if the employer is illegally uninsured for workers' compensation. Utilization review (UR): The process used by claims administrators to decide whether to authorize and pay for treatment recommended by the treating physician or another doctor. V Vocational & return to work counselor (VRTWC): If the Injured Worker has a permanent disability, this is the person or entity that helps him/her develop a return to work strategy. They evaluate Injured Worker, provide counseling and help him/her get ready to work. A VRTWC must have at least an undergraduate degree in any field and three or more years of full time experience. Page 18 of 20

19 Vocational rehabilitation (VR): A workers' compensation benefit. If Injured Worker was injured before 2004 and are permanently unable to do his/her usual job, and the employer does not offer other work, they would qualify for this benefit. It includes job placement counseling to help him/her find another job. It may also include retraining and a vocational rehabilitation maintenance allowance. Vocational rehabilitation maintenance allowance (VRMA): Payments to help you with living expenses while participating in vocational rehabilitation. See vocational rehabilitation. Voucher: See supplemental job displacement benefit and nontransferable voucher. Wage loss (temporary partial disability): See temporary partial disability benefits. W Workers' Compensation Appeals Board (WCAB): Consists of 24 local offices throughout the state where disagreements over workers' compensation benefits are initially heard by workers' compensation judges. The WCAB Reconsideration Unit in San Francisco is a sevenmember, judicial body appointed by the governor and confirmed by the Senate that hears appeals of decisions issued by local workers' compensation judges. Workers Compensation Information System (WCIS): California's workers' compensation information system (WCIS) uses electronic data interchange (EDI) to collect comprehensive information from claims administrators to help the Department of Industrial Relations oversee the state's workers' compensation system. Workers' Compensation Insurance Rating Bureau (WCIRB): An agent of the state Department of Insurance and funded by the insurance industry, this private entity provides statistical and rating information for workers' compensation insurance and employer's liability insurance, and collects and tabulates information to develop pure premium rates. Work restrictions: A doctor's description of the work the Injured Worker can and cannot do. Work restrictions help protect from further injury. Workers' Compensation Administrative Law Judge: A DWC employee who makes decisions about workers' compensation disputes Page 19 of 20

20 and approves settlements. Judges hold hearings at local Workers' Compensation Appeals Board (WCAB) offices, and their decisions may be reviewed and reconsidered by the Reconsideration Unit of the WCAB. Also called workers' compensation judge. Workers' Compensation Judge: See workers' compensation administrative law judge. Page 20 of 20

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