Glossary

ADA – Americans with Disability Act of 1990: A federal law that prohibits discrimination against people with disabilities in employment, transportation, public accommodation, communications, and governmental activities.

ADAAA – The ADA Amendments Act of 2008 was enacted on September 25, 2008, and became effective on January 1, 2009. The law made a number of significant changes to the definition of “disability” under the Americans with Disabilities Act (ADA). The Act emphasizes that the definition of disability should be construed in favor of broad coverage of individuals to the maximum extent permitted by the terms of the ADA. It also directed the U.S. Equal Employment Opportunity Commission (EEOC) to amend its ADA regulations to reflect the changes made by the ADAAA.

A.D.- Administrative Director: Is the Administrative Director of the Division of Workers’ Compensation. The A.D. is charged with adopting, amending or repealing rules and regulations to implement, carry out, and clarify many laws in the Labor Code. The A.D. also has many other responsibilities that are specifically outlined in the Labor Code.

AME – Agreed Medical Evaluator: Labor Code § 4062.2 allows represented parties to use an agreed doctor to resolve disputes arising out of an injury or claimed injury.

CFRA – California Family Rights Act (Gov. Code, § 12945.2) contains family care and medical leave provisions for California employees. Leave provisions cover employers who do business in California and employ 50 or more part-time or full-time people. Secures leave rights for the birth of a child for purposes of bonding, placement of a child in the employee’s family for adoption or foster care, for the serious health condition of the employee’s child, parent or spouse, and for the employee’s own serious health condition.

CMS – Centers for Medicare & Medicaid Services: The federal agency that administers the Medicare program. In addition, CMS works with the States to run the Medicaid program and the State Children’s Health Insurance Program (SCHIP).

DFEC – Diminished Future Earning Capacity: Labor Code § 4660(a) provides that for injuries occurring before January 1, 2013, “in determining the percentages of permanent disability, account shall be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and his or her age at the time of the injury, consideration being given to an employee’s diminished future earning capacity.

DWC – Division of Workers Compensation: A division within the state Department 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.

FMLA – Family and Medical Leave Act of 1993: A Federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave.

IBR – Independent Bill Review: Labor Code § 139.5 provides that the Administrative Director shall contract with one or more independent bill review organizations to conduct reviews. IBR was added pursuant to SB 863 to provide an unbiased method to resolve medical billing dispute resolution and reduce costs.

IMR – Independent Medical Review: Labor Code § 4616.4 provides for IMR in cases of MPN disputes. SB 863 has expanded the use of IMR per Labor Code § 139.5 which provides that the Administrative Director shall contract with one or more medical review organizations to conduct reviews. All appeals from utilization review determinations under Labor Code § 4610 will either be subject to a second UR review or directed to the Independent Medical Review process.

MMI – Maximal Medical Improvement: The point at which an injured workers condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. See P&S.

MPN – Medical Provider Network: 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.

MSA – Medicare Set-Aside: An MSA is an allocation created from the settlement of a workers compensation case. It is established from a portion of the settlement to be used to pay for future medical care that is related to the work injury and that would otherwise be covered by Medicare.

PD – Permanent Disability: Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. Also commonly referred to the benefits an injured worker may receive as a result of his/her permanent disability.

PPD – Permanent Partial Disability: Per Labor Code § 4452.5 (b), “Permanent partial disability” means a permanent disability with a rating of less than 100 percent permanent disability.

PTD – Permanent Total Disability: Per Labor Code § 4452.5 (a), “Permanent total disability” means a permanent disability with a rating of 100 percent permanent disability only.

PTP – Primary Treating Physician: The doctor having overall responsibility for treatment of an injured workers work injury or illness. The responsibility of the PTP are set out in California Code of Regulation Title 8, § 9785.

P&S – Permanent and Stationary: Per California Code of Regulation Title 8, § 9785 (a)(8), “Permanent and stationary status” is the point when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment.

QME – Qualified Medical Evaluator: Labor Code § 4060 et. seq. allows for the assignment of an independent physician certified by the DWC Medical Unit to perform medical evaluations.

SJDB – Supplemental Job Displacement Benefit: For injuries occurring on or after January 1, 2004, and before January 1, 2013, Except as provided in § 4658.6, if the injury causes permanent partial disability and the injured employee does not return to work for the employer within 60 days of the termination of temporary disability, the injured employee shall be eligible for a supplemental job displacement benefit in the form of a nontransferable voucher for education-related retraining or skill enhancement, or both, at state-approved or accredited schools. Also referred to as a voucher.

TPD – Temporary Partial Disability: Payments you get if you can do some work while recovering, but you earn less than before the injury. Per Labor Code § 4654, if the injury causes TPD, the disability payment is two-thirds of the weekly loss in wages during the period of such disability.

TTD – Temporary Total Disability: Benefits that are paid to an injured worker who is temporarily medically disabled from returning to work as a result of his or her industrial accident. These benefits are payable at two-thirds of the injured employee’s wages, with a maximum amount set forth by the Labor Code.

UR – Utilization Review: Labor Code § 4610 provides the process used by employers or claims administrators to review treatment requests to determine if they are medically necessary.

WCAB – Workers’ Compensation Appeals Board: Consists of 24 local offices throughout the state where disagreements over workers’ compensation benefits are initially heard by workers’ compensation judges. The WCAB Reconsideration Unit in San Francisco is a seven-member, judicial body appointed by the governor and confirmed by the Senate that hears appeals of decisions issued by local workers’ compensation judges.