Glossary of workers’ compensation terms
Below are some brief explanations of common terms in the workers’ compensation process. If you have specific questions or concerns, consult with a El Monte workers’ compensation attorney directly.
California Code – This is the body of law in California that provides the right to workers’ compensation benefits and sets out the requirements for eligibility and employers.
Claim form – This is the form you and your employer need to complete and send to the workers’ compensation insurance company.
Claims administrator – Also known as a claims examiner or adjuster, this is the party for the insurance company that will review your claim and grant or deny benefits.
Compromise and release (C&R) – If you agree to a lump-sum settlement with a workers’ compensation insurance company, this is one type of settlement you might reach. A workers’ compensation judge must approve the settlement agreement.
Death benefits – When a work injury or illness is fatal, the surviving dependents can seek such benefits from the workers’ compensation insurer.
Denial of claim – An insurance company can deny your benefits if it believes you do not meet the qualifications for workers’ compensation. The company must inform you of the reason for the denied claim.
Disability – This is a physical or mental impairment from your injuries or illness that restricts your work and everyday activities. A disability might be permanent, temporary, partial, or total. Your disability level is examined by a disability rater working for the DWC Disability Evaluation Unit.
Division of Workers’ Compensation (DWC) – This is the division of the California Department of Industrial Relations (DIR) that oversees workers’ comp claims, helps to resolve disputes, and informs workers of their rights and responsibilities.
Employee and Employer – An employee is an individual who performs job duties under the supervision and control of a company or entity. This includes temporary, part-time, seasonal, minor, and undocumented employees. An employer is the entity that controls another’s work activities.
Future benefits – You have the right to receive ongoing benefits for future medical treatment needed for your injuries, as well as future lost earning capacity due to disabling injuries.
Hearing – If you have a workers’ compensation dispute or are reaching a settlement agreement, the matter might have to go before a workers’ compensation judge at this type of proceeding.
Maximum medical improvement (MMI) – When your condition will likely remain the same regardless of medical treatment within the next year, a doctor might determine you have reached MMI.
Modified work – This refers to changes to your previous job activities to accommodate for your injury or disability. If your injury prevents you from performing your prior job duties, your employer can offer modified work instead of you receiving additional workers’ compensation benefits for job displacement.
Predesignated physician – Your employer must inform you of your right to predesignate a doctor to treat you if you are injured or ill from work. If you do, you can see that medical provider for your initial treatment.
Settlement – If you will continue needing benefits in the future, the insurance company might offer you a settlement instead of paying ongoing benefits. A judge must approve such settlements.
Uninsured employers fund (UEF) – This is a fund overseen by the DWC that provides benefits to injured workers whose employers failed to have proper workers’ compensation coverage.
Workers’ Compensation Appeals Board (WCAB) – These are the state offices (23 in total) that review disputes regarding workers’ compensation claims and benefits.Workers’ compensation lawyer – This type of legal professional represents workers during the claim process, including preparing and filing initial claims, appealing denials, reviewing settlement offers, and much more. Anyone seeking benefits should consult with a workers’ comp attorney.
