WORK COMP SPEAK
The Workers Compensation system is an alphabet soup of terms that are commonly used by practitioners that can seem confusing and off-putting when first encountered. Below is a list (by no means complete) of some of the most common terms you will likely hear.
Applicant: The injured worker who has invoked the WCAB to oversee the conduct and resolution of his or her Workers’ Compensation case. In a civil lawsuit this would be the plaintiff.
AA: The Applicant’s Attorney.
AHM: The Anaheim Workers Compensation Appeals Board.
AME: An Agreed Medical Examiner. This is a doctor that both sides agree is likely to be thorough and be able to honestly and correctly evaluate the disability in a case. WCAB judges are supposed to give AME opinions “great weight” in determine the outcome of disputes over the nature and extent of disability.
ANA: The Santa Ana WCAB.
C&R: Compromise and Release. This is the term for a settlement of a Workers Compensation Case in which the applicant relinquishes the right to lifetime medical care and the right to possibly reopen a case for new and further disability after an award, in exchange for a lump some of money. A C&R must be done on an officially prescribed form and must be approved by a WCAB judge to be valid.
DA: Defense Attorney. This is the attorney appointed by the employer or insurance company to try too keep benefits and payments to the injured worker as low as possible.
EAMS: Electronic Adjudication Management System. This is an online portal to information about WCAB cases and the ‘paperless” system of files in use by the WCAB and its judges.
F&A: Findings and Award. The resolution of a WCAB case by a means other than a C&R in which a judge makes certain findings of fact and then issues an award of benefits based on those findings. An F&A may issue following trial of a case or may issue based on agreement (stipulations) of the parties. An F&A usually results in less money to the injured worker than a C&R but also usually includes access to lifetime medical care.
I&A OFFICE: Information and Assistance. I & A offices are at the WCAB local office, and I &A officers are charged with responsibility of providing information to the public about the WCAB and its procedures. They will assist (but not necessarily advocate for) an injured worker who chooses not to be represented by counsel.
LBO: The Long Beach WCAB
MMI (P&S): Maximum Medical Improvement or Permanent and Stationary. This term is used by doctors to indicate that, for the foreseeable future, a medical condition has stabilized and is not expected to get appreciably worse or better. As of 2005 the term was changed from Permanent and Stationary to Maximum Medical Improvement but the meaning remains the same. The term opens the door for an injured worker to receive a permanent disability rating and therefore an award or settlement of the case.
MPN: Medical Provider Network. This is a list of doctors who have an agreement with the employer or insurance carrier to provide treatment at specially negotiated rates. As long as a claim is accepted or on a delay status the injured worker is supposed to select an MPN doctor for treatment, and failure to do so may well subject the employee to having to pay for the treatment obtained. An employee may change treating doctors within the MPN whenever desired.
MSC: Mandatory Settlement Conference. One of several types of WCAB appearances. The MSC is set at the point where the case should be positioned for settlement or trial, and further legal discovery is cut off.
OWO: Off Work Order. This is provided by the treating physician if he or she feels the injured worker must stay off work in order to properly heal from the injury or to recover from surgery.
PD: Permanent Disability. This is the benefit provided by the Labor Code according to complex formulas derived from the MMI report, the AMA Guides to the Evaluation of Impairment 5th Edition, and a formula that takes the doctor’s findings and translates them into a percentage of disability on a scale of 0-100% and which takes into account the nature of the injury, the impairment from the injury, the age at time of injury, and the occupation of the injured worker. Correct evaluation of PD is one of the most litigated issues in Workers Compensation cases. PD can be PPD (permanent partial disability) or PTD (permanent total disability or 100% PD).
QME (PQME): Qualified Medical Examiner. This is a doctor who has taken special training and has been recognized by the State of California as having the necessary knowledge to properly evaluate the medial issues in a Workers Compensation case. If the parties are represented by counsel the QME is selected from a panel 3 doctors provided by the DWC Medical Unit through a special process where each side eliminates one proposed candidate, leaving one doctor (the PQME or panel QME) to do the evaluation.
PTP: Primary Treating Physician. This is the doctor primarily responsible for supervising the treatment of the injured worker. There may be many treating doctors in multiple specialties but the PTP is supposed to review and incorporate the findings and conclusions of the other doctors into his or her report.
SDI: State Disability Indemnity. This is a benefit payable through the Employment Development Department (EDD) for each day the injured worker has an off work order and for which the employer or insurance carrier is not paying Temporary Disability. SDI benefits are obtained via a doctor’s certification of off work status.
SDO: The San Diego Workers Compensation Appeals Board.
TD: Temporary Disability. This benefit is payable at 2/3 of the injured worker’s average weekly earnings for each day the doctor provides an off work order as a result of a work injury. The benefit is subject to maximum and minimum limits and may only be paid for 104 weeks within 5 years of the date of injury. TD can be total (TTD) or payable for wage loss due to work restrictions (TPD or temporary partial disability). The time limitation on payment TPD is much longer than the limit for paying TTD noted previously.
U&C: Usual & Customary. The term refers to the normal job an individual was doing when injured. Temporary inability to do the usual and customary job will result in some form of disability payment unless the employer can offer alternative or modified work.
WCAB: The Workers Compensation Appeals Board. This is the administrative agency that resolves disputes in Workers Compensation Cases. There are offices of the WCAB in each county, and larger counties likeLos Angeles or Orange may have multiple offices.
Certified Specialist, Workers' Compensation, The State Bar of California
Board of Legal Specialization