Workers' Compensation Jargon

AME (Agreed Medical Examiner)

Physician employed by all parties to examine employee and render report that parties tacitly agree will be accepted as basis for resolving all disputed issues.

AOE-COE (also Injury AOE-COE)

An injury on the job. (Arising out of and in the course of employment). Prerequisite to right to any workers' compensation benefits.

Answer

One page form filed by the employer indicating the issues to be litigated and benefits paid.

Application or "App"

One page form filed with the WCAB and Application indicating the basic allegations regarding injury, employment, insurance coverage, benefits paid, medical treatment, and issues to be litigated. (NOTE: For injuries before 1/1/90, and after 1/1/94, this document creates WCAB jurisdiction; a separate form with the same name is used to request a hearing on cases involving injuries between 1/1/90-12/31/93).

Apportionment

That part of the P.D. not related to the industrial injury in question. Also used to refer to division of liability between employers/carriers.

"Baird" and "Gregory" formulas

Formulas used in a lump sum settlement to reduce reimbursement to EDD ("Baird") or to medical lien claimant ("Gregory") on lien claim where injury AOE-COE is disputed.

Claim form

One-page form. Employer must provide to employee within one working day after employee learns of injury. Employee completes top half, employer completes bottom, gives copy to employee, sends copy to claims examiner.

Comp rate

The rate at which temporary or permanent disability is payable to on a claim. Rate will usually be higher for T.D. than P.D.

Compromise and Release or "C&R"

A document executed by the parties to settle a case by lump sum payment which terminates all future liability of the employer. If approved by the judge, an Order Approving C&R is issued. Unlike Stips, employee cannot reopen case or obtain further medical care. (NOTE: The right to future vocational rehabilitation benefits may or may not be settled. See "Thomas finding" and "Rodgers language" below).

C&R Addendum

Most defense attorneys add an addendum of various provisions to a C&R that covers matters that are not set out in the pre-printed C&R form.

Consultant

The Rehabilitation Unit employee who monitors the vocational rehabilitation case and issues "Determinations" (formerly called Decisions and Orders).

"CT" or Cumulative

Refers to an injury resulting from stress and strain, or exposure to toxic materials, noise, emotional stress, etc. over a period of time, rather than one related to a specific incident.

Death benefits

Death benefits are payable (amounts vary) to employee's dependents when employee killed outright on job or later dies from effects of injury. Usually payable on a periodic basis at the T.D. rate. Special death benefits may be available to dependents of law enforcement or firefighting personnel. Some private companies have special death benefits in addition to any life insurance programs.

DR, DOR, or Declaration of Readiness to Proceed

One page form filed with the WCAB Readiness to proceed requesting that a hearing be set. (NOTE: For injuries from 1/1/90-12/31/93, an Application for Adjudication is filed to request an initial hearing; if the case goes off-calendar, a DOR is then used to request a further hearing).

Determination (formerly D&O)

Formal findings of fact and order issued by the Rehab Unit.

Earnings

Injured worker's actual/average earnings at time of injury or earning capacity. Used to calculate the T.D. and P.D. comp rates.

EDD lien

Claim by EDD against award of T.D., VRMA, VRTD, PD, or lump sum settlement, for reimbursement of UCD (SDI) paid.

Expedited hearing

Hearing that can be quickly set to determine single, simple issue (such as right to continuing T.D.).

F & A

Findings and Award. Findings of fact and award of compensation benefits. Made by the judge after trial or submission on the record at a hearing.

Future med

Medical treatment required in future to cure/relieve the effects of the on the job injury. In theory, it is available for life.

Informal/formal rehab conference

An informal conference is between the representatives of the employee, employer, and the rehab counselor to discuss rehab issues. A formal conference involves the same parties, but takes place at the Rehabilitation Unit and is usually followed by the issuance of a formal Determination.

Lost-time injury

An injury which results in payment of T.D.

MSC or Mandatory Settlement Conference

Similar to a Pretrial Conference, but discovery is usually closed, and parties must disclose potential witnesses and documents to be offered in evidence at trial.

Maximum

Means earnings that produce the highest rate of T.D. or P.D. payable by law depending on the date of injury. Sometimes the P.D. rate is maximum, but T.D. rate is not.

Medical award

Award of further medical care issued by judge after trial or on approval of Stipulations with Request for Award.

Medical file

The medical reports that show treatment and examination, and evaluation of permanent disability and need for future medical treatment. Filed with the WCAB and exchanged with the other party.

Medical-legal or Med-lit

Refers to reports by foresenic medical consultants to the parties, or bills for such reports or copies of medical records, etc.

Medical lien

Claim by medical care provider or health insurance carrier for unpaid medical services.

Medical only

An injury that resulted only in payment of medical expenses, without any compensable time lost from work.

Minimum

Means the earnings produce either minimum T.D. or P.D. comp rate.

Notice of Hearing

One page notice from the WCAB to all parties, indicating date, time, place and type of hearing to be held.

Objective Factors

X-ray or other evidence observed by the doctor which shows permanent disability.

Panel QME

Qualified Medical Examiner selected from a list of three provided to an employee not represented by an attorney. Doctor evaluates disability and prepares report on medical issues. (See also QME, below).

QRR

Qualified Rehabilitation Representative. Provides information to injured worker regarding rehabilitation for injuries 1/1/90-12/31/93.

P & S

Permanent and stationary. Means injured worker's medical condition has stabilized, and may have resulted in compensable P.D.

P.D.

Permanent disability. The residual, permanent effects of an injury.

P.D., P.D.R., or P & S Exam

A medical exam scheduled to determine if worker is P & S, and the objective and subjective factors of permanent disability.

P.D.R, med-lit, or P & S Report

A medical report indicating P & S status.

PDR Schedule

Manual published by the Division of Workers' Compensation used to "rate"permanent disability.

Pretrial Conference

Informal hearing between a judge and attorneys to determine issues and resolve problems. No evidence taken and witnesses do not appear. (See Mandatory Settlement Conference, above).

QIW

Qualified Injured Worker. Means disability precludes return to work in old job, and worker is expected to benefit from vocational rehabilitation services.

QME

Qualified Medical Examiner. Doctor used by a party to evaluate disability and prepare report on medical issues. (See Panel QME above).

Ratable

An objective or subjective factor of disability that can be used in a rating formula to produce a P.D. award. (Some factors of disability are "non-ratable").

Rating Conference, Rating Calendar, or Rating Pre-Trial

Medical reports indicating permanent disability are evaluated by a "rater', and parties try to settle case. No evidence taken and witnesses not required.

Recon or Reconsideration (and Petition for)

The first step in obtaining review and reversal of a decision by the workers' compensation judge. Either a panel of three (or all seven) WCAB commissioners review the judge's decision and affirm, reverse, or modify it, or direct further proceedings.

Regular or Trial Hearing

Witnesses may testify and other evidence submitted. Judge takes case under submission.

Rehab Appeal

Request by either party to have a Determination of the Rehabilitation Unit reviewed by a workers' compensation judge. The judge can affirm or reverse the Unit decision after a trial de novo.

Rehab counselor

A person with experience in the training and placement of injured workers in new jobs. Assists employee with retraining and return to work. Counselor's services are paid for by the employer.

Rehab Plan

A formal vocational rehab program. In some situations, must be approved by the Rehabilitation Unit.

Rehabilitation Unit

The agency which has primary responsibility for insuring that vocational rehab services are provided.

Rodgers language

Language included in Compromise & Release which indicates that any injury which has happened or which may later occur while employee participates in vocational rehabilitation is settled, as well as the original injury claim(s).

S & W

Serious and willful misconduct of the employer which caused the on the job injury. If proven, results in a penalty of 50% times the normal compensation benefits, without limit. Must show either a violation of a state safety order, or "failure to provide a safe place to work". (Employee can be guilty of serious and willful misconduct which may reduce award by 50%).

Self-procured medical

Medical treatment paid for by the injured worker or health and accident carrier, and not by employer.

Specific

Refers to an injury resulting from an incident on a specific date.

Statute defense

Means all or part of claim may be barred by the statute of limitations. Rarely asserted successfully.

Stipulated F & A or Stips

F & A issued by judge based on the agreed-facts stipulated to by the parties, rather than evidence heard at trial. One method of settling the case without trial.

Subjective Factors

The verbal complaints of the worker which the doctor sets forth in a medical report.

Take nothing

A decision by the judge (or the commissioners on recon) which awards no compensation to the injured worker. Relatively rare.

T.D. (and VRTD)

Temporary disability benefits paid while recovering from an injury. Also referred to as "medical T.D." (VRTD is paid while participating in vocational rehabilitation for injuries prior to 1/1/90; VRMA is paid for injuries on or after 1/1/90).

Third-party case

Civil action by the injured worker against a person other than his employer or a co- employee for damages for the on the job injury.

Thomas Finding

Parties request a "Thomas finding" when the right to future vocational rehabilitation benefits are settled. Under Thomas v. Sports Chalet, the judge must find that there is a good-faith issue which, if resolved against the employee, would defeat the right to any workers' compensation benefit. Parties must cite evidence in the C&R that supports the finding. Typical issues are statute of limitations, injury AOE-COE, no employment relationship at time of injury.

UCD benefits (SDI)

Paid at up to the T.D. rate for maximum of twelve months by the state Employment Development Department where the employer denies injury AOE-COE, or denies liability for T.D., VRTD, or VRMA.

Vocational Rehabilitation (Voc Rehab, or Rehab)

Job retraining/placement services provided at the employer's expense where injured worker cannot return to job in which working at time of injury, or usual and customary occupation.

VR Attorneys' Fees

Separate category of fees paid to employee's attorney for handling vocational rehabilitation aspect of case.

VRMA

Vocational rehabilitation maintenance allowance. Paid after employee is P&S and while participating in vocational rehabilitation. For injuries on or after 1/1/90.

VRMA Supplement

Difference between TD and lower, VRMA rate, payable to employee (on request) as an advance against PD award.

Waiting period

The period of time lost from work before T.D. is payable. No payment during this period, unless temporary disability lasts long enough; then paid retroactively to the date of injury. Does not apply to payment of medical treatment.

Writ (or Petition for Writ of Review)

The next step in the review process after reconsideration by the WCAB. Filed with one of the District Courts of Appeal. About 10-15% granted.

132a

Section of the Labor Code which broadly prohibits employment discrimination where on the job injury has occurred. If proven, can result in a penalty of 50% times the normal workers' compensation benefits (up to a maximum of $10,000), reimbursement for lost wages, plus reinstatement in job and lost fringe benefits.

4050, 4061, 4062

Sections of the Labor Code governing medical-legal exams and reports.

90-day period

Period of time after claim form filed with employer within which employer must reject claim to avoid presumption that injury is work-related and compensable.