Glossary of California Workers’ Compensation Terms
When it comes to filing a workers’ compensation claim in California, you might feel like you need to carry a dictionary around to keep up with all the new and confusing terms. Claims administrators, medical evaluators, and the Workers’ Compensation Appeals Board (WCAB) all use a specialized vocabulary during the claims and appeal process. To help injured workers feel informed and empowered, the Southern California workers’ compensation attorneys at Invictus Law, P.C., put together the following glossary of key terms you’ll likely encounter throughout your claim. This guide is written with real-world relevance in mind, so you’ll know not only what these specialized terms mean but also what they have to do with your case.
Accepted Claim
An “accepted claim” means the workers’ compensation insurance carrier has agreed that your injury or illness is work-related and that you are entitled to benefits. Acceptance triggers the carrier’s obligation to provide medical treatment and temporary disability payments when appropriate. It contrasts with a “denied claim,” where the insurer disputes liability.
Applicant
The injured worker is called the “applicant” in workers’ compensation proceedings. If you hire an attorney, they represent you in the role of “applicant’s attorney.” This term is used primarily in WCAB documents and hearings.
Applicant Attorney
An applicant attorney is a lawyer who represents injured workers—not insurance companies. Invictus Law, P.C. is an applicant firm dedicated to helping Southern California workers in Orange County and the Inland Empire secure benefits and protect their rights. Attorney fees in workers’ compensation claims are set by law and paid out of your settlement, not upfront.
Apportionment
Apportionment refers to determining what percentage of a worker’s permanent disability was caused by the work injury versus other factors, such as pre-existing conditions. Under California Labor Code §4663, physicians must address apportionment when issuing a permanent disability report. The percentage attributed to work ultimately affects the dollar value of your permanent disability award.
Authorized Treating Physician
This is the doctor approved by the insurance company or selected from the employer’s medical provider network (MPN). Your authorized treating physician controls your ongoing medical care and plays a major role in your disability status and work restrictions.
Claims Administrator / Adjuster
The claims administrator, often called the “adjuster,” is the insurance representative assigned to manage your file. They approve or deny treatment, issue temporary disability payments, and communicate with your employer and doctors. Their decisions significantly impact your case, which is why many injured workers choose to work through their attorney rather than communicating directly with the adjuster.
Cumulative Trauma (CT) Injury
A cumulative trauma injury occurs over time rather than in one single event. Repetitive stress, repetitive motion, prolonged exposure to harmful conditions, or continuous physical strain can cause CT injuries. Under Labor Code §3208.1, cumulative trauma injuries are fully compensable when proven with medical evidence.
Date of Injury (DOI)
For specific injuries, DOI is the date the incident occurred. For cumulative trauma injuries, it is generally the date the worker first suffered disability and knew or should have known the condition was work-related. This date matters because it affects filing deadlines, temporary disability eligibility, and which insurance carrier is responsible.
Declaration of Readiness to Proceed (DOR)
A DOR is a form filed with the WCAB to request a hearing. Applicant attorneys typically file a DOR when the insurance company is causing unreasonable delays, refusing treatment, disputing temporary disability, or not properly addressing permanent disability.
Denied Claim
A denied claim means the insurance carrier disputes that your injury is work-related. A denial does not end the process; your attorney can challenge the denial through Qualified Medical Evaluations, hearings, and trial if necessary.
Disability Benefits
Disability benefits include temporary disability (TD), permanent partial disability (PPD), and permanent total disability (PTD). These benefits replace lost wages when you cannot work or compensate you for long-term impairment.
Employer’s First Report of Injury (Form 5020)
This is the form an employer files to notify the insurance carrier after an employee reports a workplace injury. Workers are not responsible for filing this form, but delays on the employer’s side can slow down a claim. California law requires employers to provide the injured worker with a claim form (DWC-1) within one working day of learning about the injury.
Future Medical Care (FMC)
In cases involving permanent impairment, the insurance carrier may become obligated to provide medical treatment for the injury long after the claim is resolved. A permanent disability award may include a stipulation that the carrier must continue covering medically necessary treatment for life.
Independent Medical Review (IMR)
IMR is the process used when medical treatment is denied, delayed, or modified after utilization review. IMR reviews are conducted by independent medical experts selected by the state, not by the insurance company. Under Labor Code §4610.5, IMR decisions are binding.
Maximum Medical Improvement (MMI)
MMI, also known as “permanent and stationary” (P&S) status, means your condition has stabilized and is unlikely to improve significantly with further treatment. Once MMI is reached, the focus shifts from temporary disability to permanent disability assessment.
Medical Provider Network (MPN)
An MPN is the insurance company’s network of approved doctors. Injured workers typically must treat within the MPN unless specific exceptions apply. When disputes arise, a Qualified Medical Evaluator often becomes involved.
Permanent Disability (PD)
Permanent disability refers to a lasting impairment resulting from a work injury. PD benefits are based on your disability rating, which is calculated using the AMA Guides, age, occupation, and apportionment. PD can be partial or total.
Permanent Disability Rating (PDR)
After reaching MMI, your physician issues a report describing your impairment. That report is translated into a numerical disability rating, which determines the monetary value of your permanent disability benefits. Ratings may be adjusted by the Disability Evaluation Unit (DEU).
Primary Treating Physician (PTP)
The PTP manages your medical treatment, writes progress reports, determines work status, and eventually issues the MMI report. Their opinion is highly influential in your case.
Qualified Medical Evaluator (QME)
A QME is an independent doctor certified by the Division of Workers’ Compensation (DWC) who evaluates disputed medical issues. When the injured worker is unrepresented, the state assigns a QME panel. When represented, attorneys can request a panel and strike one physician from the list.
Temporary Disability (TD)
Temporary disability benefits replace lost wages when you can’t work or are placed on restricted duty. TD is divided into:
Temporary Total Disability (TTD): No work of any kind allowed.
Temporary Partial Disability (TPD): You can work with restrictions but earn less than before.
Under Labor Code §4656, TD benefits generally last up to 104 weeks, with limited exceptions for severe injuries.
Utilization Review (UR)
UR is the insurance company’s process for determining whether medical treatment requested by your doctor is medically necessary. If UR denies or delays treatment, the injured worker can request Independent Medical Review (IMR).
Workers’ Compensation Appeals Board (WCAB)
The WCAB is the judicial body that resolves disputes between injured workers and insurance companies. If your case requires a hearing, it will occur at one of the WCAB district offices, including those serving Orange County (Anaheim, Santa Ana) and the Inland Empire (San Bernardino).
Work Restrictions
These are physical or medical limitations placed on you by your physician. Restrictions may determine whether you return to modified duty, remain off work, or receive temporary disability payments. Employers must attempt to provide work that complies with these restrictions.
Workplace Injury
Any injury arising out of and in the course of employment qualifies for workers’ compensation benefits under Labor Code §3600. This includes specific injuries, cumulative trauma injuries, aggravation of pre-existing conditions, and some psychiatric injuries when statutory requirements are met.
Contact Invictus Law for Help With Workers’ Compensation Claims in Orange County and the Inland Empire
Understanding the terminology used in California workers’ compensation claims makes the entire process less intimidating and helps injured workers protect their rights. When you know what these terms mean and how they affect your benefits, you can make informed decisions and avoid common pitfalls. From our offices in Orange and Ontario, Invictus Law, P.C. is here to help clarify the process, advocate for your treatment and compensation, and stand by you at every stage of your claim. Contact us today.
