Talking the Talk When It Comes to Workers' Compensation

The world of Workers' Compensation law is constantly changing but that does not mean that as a client you should be confused or left in the dark. From QME medical abbreviations to unfamiliar terminology, it can become an alphabet soup of acronyms and definitions. Do not worry! We are here to help.

The glossary below is designed to shed some light on the common verbiage used in the course of a Workers' Compensation case and give you a handy list of terms to be aware of.

Workers' Compensation Acronyms

AMA—American Medical Association Guidelines to Permanent Impairment 5th Edition

The American Medical Association guidelines to permanent Impairment 5th Edition, or AMA, provides standardized criteria for evaluating and rating permanent impairments to ensure consistent and objective medical assessments.

AME --Agreed Medical Examiner

An Agreed Medical Examiner, or AME, is a doctor jointly chosen by both sides in a Workers' Compensation case. The Agreed Medical examiner will provide impartial medical evaluation for the use of both the patient and their lawyer.

App—Application for Adjudication of Claim

The Application for Adjudication of Claim, or APP, is a formal request to resolve disputes in regard to Workers' Compensation benefits. It starts off the legal process and is created to help address and settle said disputes.

CCC—California Compensation Cases

California Compensation Cases, or CCC, encompass legal disputes and rulings concerning Workers' Compensation claims specifically within the jurisdiction of California. These cases provide valuable precedents and insights into the application of Workers' Compensation laws in the state.

CWCR—California Workers’ Compensation Reporter

The California Workers’ Compensation Reporter, or CWCR, is a digital publication that discusses legal issues in California. They offer up to date information and analysis on Workers Compensation Laws and other court cases.

DWC—Division of Workers’ Compensation

The Division of Workers’ Compensation, or DWC, is an organization put in place to oversee and regulate Workers’ Compensation laws to most effectively ensure fair benefits and resources for injured employees and their employers. 

EC—Employee Claim Form

An Employee Claim Form, or EC, is a document created for employees who wish to request compensation for injuries or illnesses that occurred while at work. This form starts the process when one wishes to claim workers compensation benefits.

IMR—Independent Medical Review

The independent Medical Review, or IMR, is an unbiased third party in charge of evaluating medical decisions made by healthcare providers to ensure accuracy across the board in the care of Workers’ Compensation clients.

MMI—Maximum Medical Improvement

Maximum Medical Improvement, or MMI, refers to the point in a patient’s journey in which a patient's medical condition has stabilized, and further significant medical improvement is not expected.

MPN—Medical Provider Network

A Medical Provider Network, or MPN, is a group of healthcare providers approved by an employer's Workers' Compensation insurance company to provide medical treatment to injured workers.

P&S—Permanent and Stationary

Permanent and Stationary, or P&S, refers to when a client or worker’s medical condition has stabilized and is not seen as needing any additional medical treatment, due to the implication the situation may not improve further.

PTP—Primary Treating Physician

A Primary Treating Physician, or PTP, is a doctor who is in charge of managing a patient’s medical care and treatment.

QME—Qualified Medical Examiner

A Qualified Medical Examiner, or QME, is a licensed physician who has been certified by the state to conduct unbiased medical evaluations to assess injuries and disabilities obtained while on the job, in accordance with legal and regulatory requirements.

RFA—Request for Authorization

A Request for Authorization, or RFA,  is a legal document medical providers must submit to gain approval from an insurer or claims administrator in order to seek treatment or care for an injured employee.

UR—Utilization Review

A Utilization Review, or UR, is an assessment that aims to find the medical validity and appropriateness of a medical procedure for an injured worker in compliance with industry standards and guidelines. 

WCAB—Workers’ Compensation Appeals Board

The Workers’ Compensation Appeals Board is a judicial board that is put in place to solve disputes related to one’s Workers’ Compensation claim. The board is also in charge of handling appeals made in these cases.