California workers' comp glossary

About 40 terms, grouped by where you'll run into them: filing, money, doctors, the legal process, and your rights. Most definitions follow the state's own glossary (DWC Fact Sheet B), rewritten so you don't need a law degree. Where there's more to know, the term links to a longer guide.

Filing a claim

DWC-1 claim form

The form you use to file a workers' compensation claim with your employer. Your employer owes it to you within one working day of learning you got hurt. Our DWC-1 walkthrough goes box by box. (formulario de reclamo DWC 1)

Claims administrator

Whoever handles your claim for your employer. Usually the insurance company or a company it hires. You'll also hear "adjuster" or "examiner." (administrador de reclamos)

Specific injury

One event, one injury: a fall, a burn, a crash on a delivery route. (lesión específica)

Cumulative injury (CT)

Damage that builds up from doing the same thing over and over, like wrists from the same motion all shift or hearing from constant noise. More on carpal tunnel and repetitive strain. (lesión acumulativa)

Date of injury

For a specific injury, the day it happened. For a cumulative injury, generally the date you first had a disability from it and knew, or should have known, it was caused by work (Labor Code section 5412). (fecha de la lesión)

Presumption of compensability

If the insurer doesn't deny your claim within 90 days of the claim form, the law presumes it's covered (Labor Code section 5402). (presunción de que la lesión está cubierta)

Uninsured Employers Benefits Trust Fund (UEBTF)

A state fund that can pay benefits when an employer is illegally uninsured for workers' compensation. (Fondo Fiduciario de Beneficios para Empleadores sin Seguro)

Money benefits

Average weekly wage (AWW)

Your average earnings per week before the injury. Disability payments are figured as two-thirds of it, within state minimums and maximums. (salario semanal promedio)

Temporary disability (TD)

The checks that replace part of your pay while you recover. How much and for how long: temporary disability. (incapacidad temporal)

Temporary total disability (TTD)

TD payments when you cannot work at all while recovering. (incapacidad temporal total)

Temporary partial disability (TPD)

TD payments when you can do some work while recovering but earn less than before. (incapacidad temporal parcial)

Waiting period

The first three days you miss. They aren't paid, unless you end up out more than 14 days or get admitted to the hospital. (período de espera)

Permanent disability (PD)

Payments for the damage that doesn't heal, once you've stopped improving. How it's figured: permanent disability. (incapacidad permanente)

Permanent disability rating

A percentage that measures your permanent disability, based on the doctor's findings, your age, your occupation and other factors. It decides how many weeks of PD you receive. (calificación de incapacidad permanente)

Permanent Disability Rating Schedule (PDRS)

The state's official schedule used to turn a doctor's impairment findings into a disability rating. (tabla de calificación de incapacidad permanente)

Apportionment

Splitting your permanent disability between the work injury and everything else, like an old injury. The "everything else" part can be subtracted. (prorrateo)

Life pension

Ongoing payments for workers with a permanent disability rating of at least 70 percent but less than 100 percent (Labor Code section 4659). (pensión vitalicia)

Supplemental Job Displacement Benefit (SJDB)

For injuries in 2013 or later, up to $6,000 for retraining when your employer doesn't offer you suitable work. Details in returning to work. (vale de beneficio suplementario por desplazamiento laboral)

Return-to-Work Supplement Program (RTWSP)

A one-time $5,000 state payment for eligible workers injured in 2013 or later who received an SJDB voucher. (Programa Suplementario de Regreso al Trabajo)

Call (323) 656-9040 or send us the short form to discuss what happened.

Doctors and medical care

Primary treating physician (PTP)

The doctor with overall responsibility for treating your work injury. (médico primario que le atiende)

Medical Provider Network (MPN)

The insurer's state-approved list of doctors for work injuries. If your employer has one, you'll usually treat inside it. See getting medical treatment. (red de proveedores médicos)

Predesignation

Telling your employer in writing, before you ever get hurt, that you want your own doctor for any work injury. The rules are strict. (designación previa de su médico)

Utilization review (UR)

How the insurer decides whether to approve treatment your doctor asks for. The reviewing doctor usually has never met you. (revisión de utilización)

Independent medical review (IMR)

A review by an independent organization under contract with the state, which you can request when treatment is denied, delayed or modified in UR. The request is generally due within 30 days of the UR decision. (revisión médica independiente)

Permanent and stationary (P&S) / maximal medical improvement (MMI)

You've plateaued. Your condition isn't expected to change much in the next year, so a doctor can now measure what's permanent. (permanente y estacionario / mejoría médica máxima)

Future medical care

An ongoing right to medical treatment for the work injury after your case is resolved. (atención médica futura)

Qualified medical evaluator (QME)

A state-certified doctor who settles medical disputes in your case. They don't treat you. How to handle the panel: QME guide. (evaluador médico calificado)

Panel QME

A list of three QMEs issued by the state. If you have a lawyer, each side can strike one name. If you do not, you choose one of the three. (panel de evaluadores médicos calificados)

Agreed medical evaluator (AME)

If you have a lawyer, a doctor your lawyer and the insurance company agree on to evaluate the dispute. (evaluador médico acordado)

The legal process

Division of Workers' Compensation (DWC)

The state agency that runs California's workers' compensation system. (División de Compensación de Trabajadores)

Workers' Compensation Appeals Board (WCAB)

Workers' comp court. Judges here decide the disputes. (Junta de Apelaciones de Compensación de Trabajadores)

Information and Assistance (I&A) officer

A free state helper for questions about your claim. They can't represent you. 1-800-736-7401. (oficial de Información y Asistencia)

Application for Adjudication of Claim

The form that opens a case at the WCAB when there is a dispute. You generally have one year to file it (Labor Code section 5405). (solicitud de adjudicación de reclamo)

Declaration of Readiness (DOR)

A form used to ask for a hearing before a workers' compensation judge. (declaración de estar listo para proceder)

Mandatory settlement conference (MSC)

A required meeting before trial to try to settle the case, usually set 10 to 30 days after a DOR. (conferencia obligatoria de conciliación)

Findings and Award (F&A)

A judge's written decision on your case, including payments and future care. It becomes final unless appealed. (conclusiones y fallo)

Petition for reconsideration

The way to appeal a judge's decision. It is generally due 20 days after service, plus 5 days if the decision was mailed within California. (petición de reconsideración)

Stipulations with Request for Award (Stips)

A settlement where both sides agree on the terms of an award. It may include future medical care, and payments are made over time. A judge must approve it. (estipulaciones con solicitud de fallo)

Compromise and Release (C&R)

A lump-sum settlement. You take the money and, in most cases, take over paying for future treatment of the injury yourself. A judge has to approve it. (acuerdo de compromiso y finiquito)

Lien

A claim for payment filed in your case by someone else, such as a medical provider owed money for treatment. (gravamen)

Your rights

Labor Code section 132a

The law that makes it illegal to punish or fire you for getting hurt or filing a claim. What to do if it happens: retaliation. (sección 132a del Código Laboral)

Third-party claim

A separate lawsuit against someone other than your employer who helped cause the injury, like the driver who hit you. Common in work car accidents. (reclamo contra terceros)

Serious and willful misconduct (S&W)

A petition you can file if your injury was caused by your employer's serious and willful misconduct. If proven, compensation is increased by one-half (Labor Code section 4553). (conducta grave e intencional)

Sources: DWC Fact Sheet B, Glossary for Workers' Compensation Terms; DWC-1 claim form; DWC Injured Worker Guidebook, Chapter 4; California Labor Code § 5402, § 5405, § 5412, § 4659, § 4553, § 132a.

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