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Workers' comp glossary

By Richard Vaughn CPCU, ARM, AIS. Reviewed November 8, 2026. Richard is an insurance professional, not an attorney. This page explains the law; it is not legal advice.

Accepted claim

A claim the claims administrator has agreed is covered by workers' compensation. Disputes about particular benefits can still arise.

Agreed medical evaluator (AME)

A doctor chosen jointly by a represented worker's attorney and the claims administrator to resolve a medical dispute.

Alternative work

A different job your employer offers because you cannot return to the one you had.

AOE/COE

Short for "arising out of and occurring in the course of employment": the injury must be caused by the job and happen while working.

Applicant

The person who opens a case at the Workers' Compensation Appeals Board, usually the injured worker.

Application for adjudication of claim

The form that opens a case at a WCAB district office when you and the claims administrator disagree.

Apportionment

The split of a permanent disability between the work injury and other causes, such as a prior injury or a non-work condition.

Benefit notice

A letter the claims administrator must send explaining which benefits you may receive and why a payment started, changed or stopped.

Claim form (DWC-1)

The form you complete to tell your employer about a work injury or illness and start the claim.

Claims administrator

The person or company that handles the claim for the insurer or self-insured employer; also called the adjuster or examiner.

Classification code

A four-digit code assigned to a type of work; each code carries its own rate per $100 of payroll.

Compromise and release (C&R)

A settlement that pays a lump sum and closes the claim, including future medical care, once a judge approves it.

Cumulative injury (CT)

An injury caused by repeated exposure or motion over time rather than a single event.

Date of injury

The day the injury happened; for a cumulative injury, the first day you had disability and knew or should have known work caused it (Labor Code §5412).

Declaration of readiness (DOR)

The form filed to ask the WCAB for a hearing once a dispute is ready to be heard.

Delay letter

A notice from the claims administrator saying a decision on the claim is delayed and what information is still needed.

Denied claim

A claim the claims administrator has rejected as not covered; the denial must be sent to you in writing.

Disability Evaluation Unit (DEU)

The DWC unit that turns medical reports into a permanent disability percentage.

Division of Workers' Compensation (DWC)

The state agency that administers the workers' compensation system, resolves disputes and assists injured workers.

Experience modification (X-mod)

A factor applied to an employer's premium that compares its actual losses to the losses expected for its size and industry; computed by the WCIRB.

Experience rating

The system of adjusting an employer's premium up or down by its experience modification.

Findings and award (F&A)

A judge's written decision after trial setting out what is owed.

Future medical

Your continuing right to treatment for the work injury after the case otherwise resolves.

Independent medical review (IMR)

The appeal process when utilization review denies, delays or modifies a treatment request; decided by an independent physician reviewer.

Information and Assistance (I&A) officer

A DWC employee who answers questions and helps resolve problems informally, without charge, especially for workers without attorneys.

Lien

A claim for payment filed against the case, most often by a medical provider.

Mandatory settlement conference (MSC)

A required meeting with a judge to try to settle before a case is set for trial.

Maximal medical improvement (MMI)

The point at which the condition is stable and unlikely to change much in the next year; also called permanent and stationary.

Medical provider network (MPN)

A group of doctors set up by the insurer or self-insured employer, approved by the DWC, from which you choose your treating doctor.

Medical treatment utilization schedule (MTUS)

The evidence-based treatment guidelines doctors and reviewers must follow in California workers' compensation.

Permanent and stationary (P&S)

The treating doctor's finding that the condition has stabilized so permanent disability can be assessed.

Permanent disability (PD)

A lasting impairment that reduces your ability to compete in the open labor market after you reach MMI.

Permanent disability rating

The percentage, from 0 to 100, that sets how many weeks of permanent disability payments are owed.

Predesignation

Telling your employer in writing, before any injury, that your personal physician should treat you if you are hurt at work.

Premium audit

The insurer's review of an employer's payroll records after the policy period to compute the final premium.

Primary treating physician (PTP)

The doctor responsible for managing your care and reporting on your condition.

Pure premium rate

The portion of a workers' comp rate, per $100 of payroll, needed to pay expected losses and loss adjustment expense; advisory in California.

Qualified medical evaluator (QME)

A physician certified by the DWC to examine injured workers and write medical-legal reports when there is a dispute.

Request for authorization (RFA)

The form the treating doctor sends to the claims administrator asking approval for a treatment.

Settlement

An agreement with the claims administrator about benefits and future medical care; a judge must review and approve it.

State average weekly wage (SAWW)

The average wage of California workers covered by unemployment insurance, used to adjust temporary disability minimums and maximums each year.

State disability insurance (SDI)

The EDD program that replaces part of your wages for a non-work disability; it can pay while a workers' comp claim is delayed or denied, subject to repayment rules.

Stipulations with request for award (Stips)

A settlement in which both sides agree on the disability percentage and future medical care, paid out over time and approved by a judge.

Supplemental job displacement benefit (SJDB)

A voucher for retraining or skill enhancement when you cannot return to your job and the employer does not offer suitable work.

Temporary disability (TD)

Wage-replacement payments while you are recovering and cannot do your usual work; temporary total (TTD) if you cannot work at all, temporary partial (TPD) if you can work with reduced earnings.

Uninsured Employers Benefits Trust Fund (UEBTF)

The state fund that pays benefits to workers whose employers illegally had no workers' compensation coverage, then pursues the employer.

Utilization review (UR)

The claims administrator's process for deciding whether a requested treatment is medically necessary under the MTUS.

Work restrictions

The doctor's list of tasks you should and should not do while recovering.

Workers' Compensation Appeals Board (WCAB)

The district offices where judges hear disputes and approve settlements, and the commissioners in San Francisco who review their decisions.

Workers' Compensation Insurance Rating Bureau (WCIRB)

The licensed statistical and rating organization for California workers' compensation insurance; it proposes advisory pure premium rates and computes experience modifications.

Questions people ask

Richard Vaughn CPCU, ARM, AIS

Richard Vaughn spent 35 years in commercial property and casualty insurance, most of it in workers' compensation: running a self-insured group, auditing premiums, and implementing claims systems for carriers and third-party administrators. He is not an attorney. dickvaughn.com