Accepted claim: A claim in which the claims administrator agrees your injury or illness is covered by workers’ compensation. Even if your claim is accepted there may be delays or other problems. Also called admitted claim.
ACOEM: American College of Occupational and Environmental Medicine. Until the state Division of Workers’ Compensation (DWC) adopts medical treatment guidelines, the guidelines published by ACOEM, called “Occupational Medicine Practice Guidelines,” are the guidelines used in most cases to decide the type and amount of treatment you’ll receive for a work injury or illness.
Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the claims administrator 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.
Alternative work: A new job with your employer. If your doctor says you will not be able to return to your regular job at the time of injury, your employer is encouraged to offer you alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured, and be within a reasonable commuting distance of where you lived at the time of injury.
American Medical Association (AMA): A national physician’s group. The AMA publishes a set of guidelines called “Guides to the Evaluation of Permanent Impairment.” If your permanent disability is rated under the 2005 rating schedule, the doctor is required to determine your level of impairment using the AMA’s guides.
Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. If you believe you’ve been discriminated against at work because you’re disabled and want information on your rights under the ADA, contact a U.S. Equal Employment Opportunity Commission office. For the EEOC office in your area, call (800) 669-4000 or (800) 669-6820 (TTY).
AOE/COE (Arising out of and occurring in the course of employment): Your injury must be caused by and happen on the job.
Applicant: The party — usually you — that opens a case at the local Workers’ Compensation Appeals Board (WCAB) office by filing an application for adjudication of claim.
Appeals board: A group of seven commissioners appointed by the governor to review and reconsider decisions of workers’ compensation administrative law judges. Also called the Reconsideration Unit. See Workers’ Compensation Appeals Board.
Applicants’ attorney: A lawyer that can represent you in your workers’ compensation case. Applicant refers to you, the injured worker.
Application for adjudication of claim (application or app): A form you file to open a case at the local Workers’ Compensation Appeals Board (WCAB) office if you have a disagreement with the claims administrator about your claim.
Apportionment: A way of figuring out how much of your permanent disability is due to your work injury and how much is due to other disabilities.
Audit Unit: A unit within the DWC that receives complaints against claims administrators. These complaints may lead to investigations of the way the company handles claims.