Jun3Written by:Bob Cohen
6/3/2010 5:33 PM
The workers’ compensation system can be difficult for anyone to figure out. One reason for this is the unique words and terms that are used throughout the workers’ compensation system. If you’ve been hurt on the job, it’s critical that you learn and understand these terms. Here are just a few you need to know.
AME: If you have an attorney, an agreed medical evaluator (AME), is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. If you don't have an attorney, you will use a qualified medical evaluator (QME). See QME below.
California Labor Code section 132a: A workers' compensation law that prohibits discrimination against you because you filed a workers' compensation claim, and against co-workers who might testify in your case.
I&A: The Information & Assistance (I&A) officer is a DWC employee who answers questions, assists injured workers, provides written materials, conducts informational workshops and holds meetings to informally resolve problems with claims. Your local I&A officers are great resources and their services are free. They are not there to act on your behalf as an attorney would, but they'll help you understand how to act on your own behalf.
Impairment Rating: An impairment rating is a percentage estimate of how much normal use of your injured body parts you've lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate your permanent disability rating but is different from your permanent disability rating.
Medical Unit: A unit within the DWC that oversees medical provider networks (MPNs), independent medical review (IMR) physicians, health care organizations (HCOs), qualified medical evaluators (QMEs), panel QMEs, utilization review (UR) plans, and spinal surgery second opinion physicians.
Permanent and stationary (P&S): Your medical condition has reached maximum medical improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted from your work injury. If your disability is rated under the 2005 schedule you will see the term maximal medical improvement (MMI) used in place of P&S.
Pre-designation: The process you use to tell your employer you want your personal physician to treat you for a work injury. You can pre-designate your personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) if: your employer offers group health coverage; the doctor has treated you in the past and has your medical records; prior to the injury your doctor agreed to treat you for work injuries or illnesses and; prior to the injury you provided your employer the following in writing:
- Notice that you want your personal doctor to treat you for a work-related injury or illness and
- Your personal doctor's name and business address.
QME: A qualified medical evaluator (QME) is an independent physician certified by the DWC Medical Unit to perform medical evaluations.
UR: Utilization review (UR) is the process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.
In future blogs, I’ll share additional terms you need to know if you’ve been injured on the job. Remember, if you’re hurt at work, you do have the right to get an attorney to represent you. An experienced workers’ compensation attorney can help you navigate the ins and outs of the workers’ compensation system and help you get the maximum allowable benefits.
If you’ve been injured at work, I wish you a speedy recovery.
Robert M. Cohen
Attorney at Law
Attorney Member, Walker & Walker Attorney Network at 1-800-THE-LAW2
PS: One last piece of information you must always keep in mind: Making a false or fraudulent workers’ compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.