American College of Occupational and Environmental Medicine. These are the guidelines published by ACOEM, called "Occupatinal Medicine Practice Guidelines" and used in most cases to decide the type of amount of treatment approved for a work injury or illness.

If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examinatino that will help resolve your dispute. If you don't have an attorney, you will use a qualified medical evaluator (QME).

A claim in which the insurance company agrees that the injury or illness is covered by workers' comp.. Even if the claim is accepted there may be delays or other problems - Also called "admitted claim"

A national physician's group. The AMA publishes a set of guidelines called "Guides to the Evaluation of Permanent Impairment." If the permanent disability is rated under the 2005 rating schedule, the doctor is required to determine the level of impairment using the AMA's guidelines.

Arising our of and occuring in the course of employment - An injury that is caused by and happens on the job.

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.

A unit within the DWC that receives complaints against claims administrators. These complaints may lead to investigations of the way the company handles claims.

The Moore-Brown Roberti California Family Rights Act of 1993 - providing unpaid job-protected time off for eligible employees with a serious health condition or who need to care for certain family members and continuation of benefits.

A biological, adopted, or foster son or daughter, a stepson or stepdaughter, a legal ward, or a child of an employee who stands in loco parentis to that child, who is either under 18 years of age or an adult dependent child.

COMPROMISE AND RELEASE

(C & R)

A type of settlement in which you receive a lump sum payment and become responsible for paying for your future medical care. A settlement like this must be approved by a worker's comp. judge.

A person against whom one of the following crimes has been committed; (1) a violent felony, (2) a serious felony, (3) a felony provision of law proscribing theft or embezzlement.

CUMULATIVE INJURY

 (CT)

An injury that was caused by repeated events or repreated exposures at work; for example a wrist injury caused by performing the same motion over and over or a loss of hearing caused by constant loud noise.

In the place of a parent; instead of a parent; charged with a parent's rights, duties, and responsibilities. It does not require a biological or legal relationship.

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.

DISABILITY EVALUATION UNIT

(DEU)

A unit within the DWC that calculates the percent of permanent disability.

DIVISION OF WORKERS' COMPENSATION

(DWC)

A division within the state Dept. 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.

Any officer, ee, or member of a fire dept or fire protection or firefighting agency of the federal govt., the state of CA, a city, county, city and county, district, or other public or municipal corporation or political subdivision of this state, or a sheriff's dept. , police dept. or a private fire dept, whether that person is a volunteer or partly paid or fully paid, while he or she is actually engaged in providing emergency services.

Duties crucial to job such that position exists to perform job function.

FAIR EMPLOYMENT AND HOUSING ACT

(FEHA)

A state law that prohibits discrimination based on protected characteristics.

A federal law that provides certain ees with serious health problems or who need to care for a child or other family members with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave.

FINDINGS AND AWARD

(F & A)

A written  decision by a workers' compensation administrative law judge, including payments and future care that must be provided to the injured worker. The F&A becomes a final order unless appealed.

HEALTH CARE ORGANIZATION

 (HCO)

An organization certified by the Dept. of Industrial Relations to provide managed medical care within the workers' compensation system.

An individual holding either a physician's or surgeon's certificate or any other individual duly licensed as a physician, surgeon, or osteopathic physician or surgeon in another state or jurisdiction, including another country, who directly treats or supervises the treatment of the serious health condition, or any other person who meets the definition of others "capable of providing heal care services" as set forth in FMLA & its implementing regulations.

A health and safety program employers are required to develop and implement. This program is enforced by CAL/OSHA.

CA state law program providing wage replacement benefits to eligible employees for time off due to seriously ill family members and administered by the EDD

A percentage estimate of how much normal use of your injured body parts you've lost,. Impairement ratings are determined based on guidelines published by the AMA. An impairment rating is used to calculate a permenent disability rating but is different from the permanent disability rating.

A right or claim for payment against a workers' compensation case. A lien claimant, 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.

MAXIMAL MEDICAL IMPROVEMENT

(MMI)

The injured worker's condition is well stabilized and unlikely to change substantially in the next year, with or without medical trreatment,. Once MMI is reached, a doctor can assess how much, if any, permenent disability resulted from the work injury.

A report written by a doctor that describes a medical condiltion. These reports are written to help clarify dispuuted 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.

Biological, foster, or adoptive parent, a stepparent, a legal guardian, or other person who stood in loco parentis to the employee when the employee was a child.

The existing position of an injured worker with some changes that allow him or her to do it. If the treating physician says the ee will not be able to return to the job at the time of injury, the employer is encouraged to offer modified work instead of supplemental job displacement benefits or vocational rehabilitation benefits.

A doucment from the insurance company that must be completed by both the injured worker and the insurance company. This is the doucment used to provide payment for education under the supplental job displacement benefit program.

The condition when the employee's medical condition has reached maximum medical improvement.

PERMANENT DISABILITY RATING SCHEDULE

(PDRS)

A DWC publication containing detailed information lused to rate permanent disabilities. One of three scheduled will be used to rate the disability, depending on the date of the injury.

A physician that can treat a work injury if the ee has advised the employer in writing prior to the work injury or illness if certain conditions are met.

PRIMARY TREATING PHYSICIAN

(PTP)

 The doctor having overall responsibility for treatment of a work injury or illness. This physician writes medical reports that may affect benefits, also called treating physician or treating doctor.

QUALIFIED INJURED WORKER

(QIW)

For workers' compensation  purpores, entitled to vocational rehabilitation benefits. This benefit applies only if the injury occurred before Jan 1, 2004.

QUALIFIED MEDICAL EVALUATOR

(QME)

An independent physician certified by the DWC Medical Unit to perform medical evaluations.

Two adults who have chosed to share one another's lives in an intimate and committed relationship of mutual caring and who file a Declaration of Domestic Partnership with the Secretary of State as defined in Section 297 of the Family Code.

A DWC EE who oversees vocational rehabilitation procedures, makes decisions about vocational rehabilitation benefits and helps resolve disputes.

SERIOUS AND WILLFUL MISCONDUCT

(S & W)

A petition filed if an injury is caused by the serious and willful misconduct of your employer.

For purposes of CFRA, this includes the following categories: (1) Inpatient care, (2) continuing treatment, (3) a period of incapacity of more than 3 consequetive calendar days, (4) a period of incapacity or treatment due to a chronic serious health condition requiring periodic visits for treatment, (5) a period of incapacity that is permenent or long-term due to a condition for which treatment may not be effective, and (6) a period of absence to receive multiple treatments by a health care provider.

As defined by Labor Code Section 233, accrued increments of compensated leave provided by an employer to an EE as a benefit of the employment for use by the EE during an absence from the employment when medicall necessary, the EE is physically or mentally unable to perform his/her duties due to illness, injury or a medical condition of the EE, or the absence is for the purpose of obtaining professional diagnosis or treatment for a medical condition of the EE.

SUPPLEMENTAL JOB DISPLACEMENT BENEFIT

(SJDB)

Voucher for payment to EEs, injured in or after 2004 with permanent partial disabilities perventing them from performing their former jobs where employer does not offer other work, for educational retraining and/or skill enhancement at state-approved or state-accedited schools.

UTILIZATION REVIEW

(UR)

The process used by insurance companies to decide whether to authorize and pay for treatment recommended by a treating physician or another doctor.

VOCATIONAL AND RETURN TO

WORK COUNSELOR

(VRTWC)

Specialist who evaluates injured worker with permanent disability rating and develops return to work strategy.

VOCATIONAL REHABILITATION

(VR)

Workers' compensation benefits, including job placement conuseling, retraining and maintenance allowance to EEs injured prior to 2004 with permanent partial disabilities preventing them from performing their former job wher employer does not offer other work.

VOCATIONAL REHABILITATION

MAINTENANCE ALLOWANCE

(VRMA)

Payments to help with living expenses while an injured worker participates in vocational rehabilitation.

A doctor's descrption of the work an injured EE can and cannot do. Work restrictions help protect the EE from further injury.

WORKERS' COMPENSATION

APPEALS BOARD

(WCAB)

An agent of the state Dept. 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 info to develop pure premium rates.