ChironAI™ OM · med-legal reference
Glossary.
Citations are to the California Labor Code ("Labor Code"), Title 8 of the California Code of Regulations ("8 CCR") and the Health and Safety Code. Product terms are given as ChironAI and MindHYVE publish them. Where a term names a screen in OM, it is marked "(OM)".
Terms A to Z
0–9
- 8 CCR
- Title 8 of the California Code of Regulations, where the Division of Workers' Compensation publishes its rules on reporting, utilization review, fee schedules and QMEs.
A
- AB 489
- California Assembly Bill 489, a law on AI in health care that ChironAI describes as "AI as decision-support, not clinician." Chiron never presents itself as a licensed clinician.
- AB 3030
- California Assembly Bill 3030, a law requiring disclosure when generative AI is used in health care communications. Every AI result in OM carries a disclosure that it is AI-generated decision support.
- Addendum
- A signed correction attached to a finalized report. In OM the original report stays intact and the addendum sits beside it, rather than the report being reissued.
- ADJ number
- The case number the WCAB assigns to a workers' compensation case in EAMS. OM prints it on every form that needs it.
- Administrative Director
- The official who heads the DWC and adopts its forms, fee schedules and rules; among other duties, the Administrative Director appoints QMEs (Labor Code §139.2).
- Admissibility (of records)
- Whether a record may be given to and relied on by a QME or AME. Labor Code §4062.3 governs how records are served and objected to, and 8 CCR §35(e) lists reports that may never be forwarded to the evaluator.
- Agentic AI
- AI that acts on delegated work, not only answers questions, while the professional remains the decider on every consequential output. MindHYVE calls this "bounded agency, never full autonomy."
- Almaraz/Guzman
- The California workers' compensation decisions that allow a physician to depart from a strict AMA Guides rating when it does not accurately reflect the worker's impairment, provided the departure stays within the Guides' framework and is explained. Chiron checks whether such a departure is justified; the physician decides.
- AMA Guides Fifth Edition
- The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fifth Edition, the book California uses to rate whole person impairment (Labor Code §4660.1, for injuries on or after January 1, 2013).
- AME
- Agreed Medical Evaluator: a physician the parties agree on to resolve a medical dispute instead of using a QME panel (Labor Code §4062.2(f)).
- AOE/COE
- "Arising out of employment" and "in the course of employment": the test for whether an injury is industrial, and so covered by workers' compensation (Labor Code §3600(a)).
- Apportionment
- Dividing permanent disability between the industrial injury and other causes. Apportionment must be based on causation (Labor Code §4663(a)).
- Assists
- A label in this guide: Chiron prepares a draft, suggestion or check, and a person on your team reviews, edits and decides.
- Automates
- A label in this guide: Chiron does the work end to end and tells you it is done, or carries a value you enter once to everywhere it is needed.
B
- BAA
- Business Associate Agreement: the HIPAA contract under which a vendor may handle protected health information for a covered entity. ChironAI makes a BAA available for institutional customers.
- BAA Registers (OM)
- The administrator screen for HIPAA records: patient rights requests, breach incidents and their notification clocks, subcontractors, agreement terms and the clinic data export.
- Bates numbering
- Sequential page numbers stamped across a set of produced records so that any page can be cited. OM numbers continuously per patient across every production.
- Binding UR denial
- A utilization review decision to modify or deny a treatment stays effective for 12 months for a further request for the same treatment by the same physician or practice group (Labor Code §4610(k)). An IMR determination is binding on all parties (Labor Code §4610.6(g)).
- Business days
- Days other than weekends and California state holidays. Chiron counts in business days only where the rule says so; otherwise it counts calendar days or hours.
C
- Causation
- Whether, and how far, the work injury caused the condition or disability. A physician reporting on permanent disability must address the causation of that disability (Labor Code §4663(b)).
- CCPA
- The California Consumer Privacy Act, which gives Californians rights over their personal information. OM tracks CCPA requests and their response deadlines in BAA Registers.
- Claims administrator
- The insurer, self-insured employer or third-party administrator that handles a workers' compensation claim and receives your reports, RFAs and bills.
- CMS-1500
- The standard paper claim form for professional services. OM generates it from a charge using the billing details you register once.
- Compensability
- Whether an injury is covered by workers' compensation at all. Disputes over compensability are resolved through a medical evaluation under Labor Code §4060.
- Comprehensive medical-legal evaluation
- An evaluation that includes an examination of the worker and produces a narrative report attested under Labor Code §4628, used to resolve a disputed medical issue (8 CCR §9793(c)).
- Consult · Round Table (OM)
- A Chiron consultation in which several specialist perspectives reason about a causation question, each visibly, before Chiron drafts a joint view for the physician to review.
- Continuing education (QME)
- The education a QME must complete to be reappointed. For applications received on or after April 1, 2026, that is 16 hours within the previous 24 months, including at least 2 hours of anti-bias training (8 CCR §55.1); earlier applications follow 8 CCR §55.
- CPT
- Current Procedural Terminology: the American Medical Association's codes for procedures and visits, used on treatment bills.
- Cumulative trauma (CT)
- An injury from repetitive mentally or physically traumatic activity over a period of time, as opposed to a single incident (Labor Code §3208.1(b)). Its date of injury is the date the worker first suffered disability and knew, or should have known, that work caused it (Labor Code §5412).
- CURES
- California's controlled-substance prescription database. Before first prescribing a Schedule II, III or IV controlled substance, a prescriber must generally review the patient's history in it (Health and Safety Code §11165.4). OM records your review but does not connect to CURES.
D
- DE 2501
- The EDD's Application for Disability Insurance Benefits, the State Disability Insurance claim form; the physician completes the medical certificate. OM prepares the physician's answers from the case.
- DE 2525XX
- The EDD's Physician/Practitioner's Supplementary Certificate, used to extend a disability claim past the original estimated recovery date.
- DEA number
- A practitioner's Drug Enforcement Administration registration number, required to prescribe controlled substances. OM prints it under your name on prescriptions.
- Deemed satisfied
- If a provider does not request independent bill review within 30 days of the second-review decision, the bill is treated as paid in full (Labor Code §4603.6(a)); the same applies to a med-legal bill with no second-review request within 90 days (Labor Code §4622).
- Defend This (OM)
- A Chiron feature that plays opposing counsel against your adopted opinions and your Doctor's First Report, then drafts a rebuttal grounded only in your own positions.
- Deposition
- Sworn testimony given out of court. An evaluator must make themselves available for deposition within 120 days of the notice unless otherwise ordered or agreed (8 CCR §35.5(f)); testimony is billed under ML204.
- DEU
- The DWC's Disability Evaluation Unit, which prepares permanent disability ratings, including summary ratings on unrepresented cases (8 CCR §10160).
- DEU-100
- DWC AD Form 100 (DEU), the Employee's Disability Questionnaire that accompanies a request for a summary rating (8 CCR §10160).
- DEU-101
- DWC AD Form 101 (DEU), the Request for Summary Rating Determination on a QME's comprehensive evaluation of an unrepresented worker (8 CCR §10160).
- DEU-102
- The DEU request for a summary rating determination on a primary treating physician's report.
- DEU-103
- The DEU request for reconsideration of a summary rating, which an unrepresented worker or the employer may make within 30 days of receiving the rating (Labor Code §4061).
- DFR (Form 5021)
- DWC Form 5021, the Doctor's First Report of Occupational Injury or Illness, due within five days of the initial examination (Labor Code §6409(a); form at 8 CCR §14006).
- Digital Employee
- MindHYVE's term for an Agentic AI Operating System that "does the work of cognition alongside the discipline's human workforce." Chiron is the Digital Employee in ChironAI.
- DME
- Durable medical equipment, such as braces or a TENS unit. OM checks DME orders against the regulations before Chiron drafts the RFA.
- DWC
- The California Division of Workers' Compensation, which administers the workers' compensation system and publishes its forms.
- DWC-AD 10133.36
- The Physician's Return-to-Work & Voucher Report, on which the treating physician records work capacities that bear on return to work and on the supplemental job displacement voucher.
E
- E/M
- Evaluation and management: the CPT code family for office visits, leveled by medical decision-making or time.
- EAMS
- The Electronic Adjudication Management System, the DWC's case system for the WCAB. Documents filed in it must meet its format rules, including PDF/A.
- EDD / SDI
- The California Employment Development Department, which runs State Disability Insurance. See DE 2501 and DE 2525XX.
- EMG/NCS
- Electromyography and nerve conduction studies, electrodiagnostic tests of nerve and muscle function. Chiron reads the tables from an EMG machine's PDF into a draft for you to confirm.
- EOR
- Explanation of Review: the claims administrator's statement, sent with a payment, adjustment or denial, of what was billed, what was paid and why (Labor Code §4603.3(a)).
- Eve-Fusion™
- MindHYVE's compound reasoning architecture. It "composes five cooperating models — the same five on every vertical": a routing classifier, a domain-trained reasoner and three frontier slots.
- Eve-Genesis™
- MindHYVE's synthetic reasoning corpus, which trains reasoning modes rather than memorized answers. Its Clinical Edition is "100% synthetic by construction," and no customer data, patient data or protected health information enters training.
- Eve-Healthcare™ F5/reasoner
- The clinical reasoner at the center of Eve-Healthcare™ Fusion v5, the composition behind ChironAI. It is a domain-trained reasoning model fine-tuned on Eve-Genesis™ (Clinical Edition) that plans the reasoning and consults the three frontier slots. Images take a separate vision route, "a parallel path rather than a sixth model."
- Ex parte communication
- A one-sided communication with an AME or panel QME, which is prohibited. The aggrieved party may elect to end the evaluation and seek a new one, or proceed (Labor Code §4062.3(g)).
F
- Face-to-face time
- The time a QME is present with the worker, taking a history, examining or discussing the condition; it excludes research, records review and report writing (8 CCR §49(b)).
- Factual correction (Form 37)
- A request, made within 30 days of receiving an unrepresented panel QME's report, for a supplemental report correcting factual errors (Labor Code §4061(d); 8 CCR §37).
- Fingerprint (SHA-256)
- A unique code computed from a finished PDF. Anyone holding the file can check it against OM's public verification page to confirm it is the exact document signed, without seeing patient data.
- Form 31.5
- The form used to request a replacement QME or a replacement panel (8 CCR §31.5).
- Form 31.7
- The form used to request an additional QME panel in a different specialty (8 CCR §31.7).
- Form 105
- The Request for Qualified Medical Evaluator Panel Form (Unrepresented Employee), used to request a QME panel when the worker has no attorney (8 CCR §30).
- Form 109
- The Notice of Qualified Medical Evaluator Unavailability, filed at least 30 days before a period of unavailability (8 CCR §33).
- Form 110
- The QME Appointment Notification Form, completed whenever a QME evaluation appointment is made (8 CCR §34).
- Form 111
- The QME Findings Summary Form, attached when a report on an unrepresented worker is served (8 CCR §36).
- Form 112
- The QME/AME Time Frame Extension Request, used to ask the Medical Director for more time to complete a report (8 CCR §38(c)).
- Form 122
- The AME or QME Declaration of Service of Medical-Legal Report Form, attached to a report to show who it was served on and how (8 CCR §36(a)).
- Form 123
- The QME form on which an evaluator discloses conflicts of interest.
- Form 124
- The QME form on which an evaluator declares financial interests. OM watermarks it as a draft until the evaluator signs.
- Functional improvement
- A clinically significant improvement in daily activities, or a reduction in work restrictions, plus reduced dependence on continued treatment (8 CCR §9792.20(e)). It is the evidence a reviewer looks for that treatment is working.
G
- Governmental payer
- A public-entity payer. It has 60 days to pay a treatment bill, where a private payer has 45 (Labor Code §4603.2(b)).
H
- HCPCS
- The Healthcare Common Procedure Coding System. Its Level II codes, published by CMS, cover supplies, equipment and services not in CPT.
- HIPAA
- The federal Health Insurance Portability and Accountability Act, whose rules govern the privacy and security of health information. ChironAI describes its controls as "HIPAA-aligned."
I
- IBR / IBR-1
- Independent Bill Review: review by an independent organization of a bill still disputed after second review. It must be requested within 30 days of service of the second-review decision (Labor Code §4603.6(a)); IBR-1 is the request form.
- ICD pointer
- The link on a bill line that names which diagnosis supports that service.
- ICD-10-CM
- The diagnosis code set used in the United States. Chiron checks every code it suggests against the official table.
- IMR
- Independent Medical Review: the only route for appealing a utilization review decision on medical necessity (Labor Code §4610.5). It must be requested within 10 days of service of the UR decision for a formulary dispute and 30 days for other treatment (Labor Code §4610.5(h)(1)).
- Information exchange
- The rule that information a party plans to give a panel QME must first be served on the other side, 20 days before it goes to the evaluator; if the other side objects to nonmedical records within 10 days, they are not provided (Labor Code §4062.3(b)).
- Interpreter late cancellation
- Unless an interpreter is told of a cancellation at least 24 hours ahead, the interpreter is paid no less than the minimum fee (8 CCR §9795.3(c)).
J
- Jamar dynamometer
- A standard hand-grip strength gauge. Chiron runs the grip protocol, calculates side-to-side percentages and variation, and cites published norms.
L
- Labor Code
- The California Labor Code, which contains the workers' compensation statutes.
- Lien (personal injury)
- A claim against a personal-injury recovery for the cost of care. OM keeps a running lien balance per case and produces a lien statement for the patient's attorney.
M
- MDM
- Medical decision-making, one of the two measures (with time) used to choose an E/M level.
- Medical Director
- The DWC's Medical Director, who assigns QME panels and acts on QME extension and unavailability requests (Labor Code §4062.1(b); 8 CCR §§33, 38).
- Medical-legal (med-legal)
- Work done to resolve a disputed medical question in a claim, such as a QME or AME evaluation, a supplemental report or testimony, as distinct from treatment.
- ML203
- Supplemental medical-legal evaluation, written after a party's request or after receiving records not available at the original evaluation (8 CCR §9795).
- ML204
- Medical-legal testimony, billed by the quarter hour; a deposition cancelled fewer than eight calendar days before it is scheduled is still paid a one-hour minimum (8 CCR §9795).
- ML205
- Review of sub rosa recordings, billed by the quarter hour (8 CCR §9795).
- ML codes
- The procedure codes in the Medical-Legal Fee Schedule (8 CCR §9795). The ML200 series applies to evaluations, testimony and supplemental reports on or after April 1, 2021: ML200 a missed appointment, ML201 a comprehensive evaluation (with an allowance of record pages included and the excess paid per page), ML202 a follow-up evaluation, and ML203 to ML205 above.
- ML modifiers
- Suffixes added to an ML code: -92 primary treating physician, -93 interpreter or impaired communication, -94 AME, -95 panel QME, -96 psychiatric or psychological evaluation (8 CCR §9795).
- MLFS
- The Medical-Legal Fee Schedule, which sets fees for med-legal evaluations, reports and testimony (8 CCR §9795).
- MME
- Morphine milligram equivalent: a standard way to total the opioid dose across different drugs. Chiron calculates it from issued prescriptions.
- MMI
- Maximum medical improvement: the condition is well stabilized and unlikely to change substantially in the next year, with or without treatment. In California it is the same point as permanent and stationary (8 CCR §9785(a)(8)).
- MPN
- Medical Provider Network: a network an employer or insurer sets up for treating injured workers (Labor Code §4616). OM copies the State's public MPN list into your records every week.
- MTUS
- The Medical Treatment Utilization Schedule, California's evidence-based treatment guidelines for workers' compensation (8 CCR §9792.20 and following).
- MTUS Drug Formulary
- The MTUS Drug List and its rules, which mark each drug Exempt (no prior authorization needed if prescribed in line with the MTUS) or Non-Exempt (8 CCR §9792.27.1). Formulary status also sets the shorter IMR window.
- MTUS/ACOEM
- The MTUS incorporates the American College of Occupational and Environmental Medicine's practice guidelines (8 CCR §9792.20(a)). Chiron checks treatment requests against them and quotes the guideline.
N
O
- OMFS
- The Official Medical Fee Schedule, which sets the maximum fees for treatment in workers' compensation (8 CCR §9789.12.1 and following, for services on or after January 1, 2014).
P
- P&S
- Permanent and stationary: see MMI. The treating physician reports P&S findings within 20 days of the examination (8 CCR §9785(i)).
- Panel (QME panel)
- A list of three QMEs issued by the DWC's Medical Director from which the evaluator is chosen (Labor Code §4062(a)).
- PD
- Permanent disability: the lasting loss of earning capacity after an injury, rated from impairment and paid under Labor Code §4658.
- PDF/A
- An archival PDF format. OM produces PDF/A filing copies of medical-report forms for EAMS, separately from the signable form.
- Penalty and interest (late payment)
- An increase on a late-paid bill: 15% plus interest on a treatment bill (Labor Code §4603.2(b)) and 10% plus 7% annual interest on the portion of a med-legal bill unreasonably unpaid (Labor Code §4622). Chiron calculates it.
- Personal injury (PI)
- An injury claim outside workers' compensation, such as a motor-vehicle accident, typically paid through a lien on the recovery.
- Pesticide-illness report
- When a physician treats pesticide poisoning, or a suspected case, a report must go to the local health officer within 24 hours of the initial examination (Labor Code §6409(a)).
- PHI
- Protected health information: individually identifiable health information covered by HIPAA.
- PHQ-2
- A two-question screen for depressed mood. Chiron shows a positive result from the patient's intake for the physician to review.
- PM&R
- Physical medicine and rehabilitation. OM's PM&R tools are on by default and appear on cases with PM&R work.
- PR-2
- Form PR-2, the Primary Treating Physician's Progress Report (8 CCR §9785.2). It is due within 20 days of a triggering event and at least every 45 days (8 CCR §9785(f)).
- PR-4
- Form PR-4, the Primary Treating Physician's Permanent and Stationary Report (8 CCR §9785.4).
- Predesignation
- A worker's advance written notice to the employer naming a personal physician, which lets the worker treat with that physician from the date of injury if the conditions are met (Labor Code §4600(d)).
- Presumption (safety members)
- A rule that certain injuries to public safety workers are presumed industrial, such as the post-traumatic stress disorder presumption for certain firefighters and peace officers (Labor Code §3212 and following, including §3212.15).
- Primary treating physician (PTP)
- The physician primarily responsible for managing the worker's care, who has examined the worker at least once and monitored the treatment (8 CCR §9785(a)(1)). Any other examining or treating physician is a secondary physician.
- Prior award (§4664)
- If the worker has a prior permanent disability award, that disability is conclusively presumed to exist at the time of a later injury (Labor Code §4664(b)). Chiron finds prior awards in the records for you to confirm.
- Proof of service
- A record of who a document was served on, how and when. For med-legal reports it is made on Form 122.
Q
- QME
- Qualified Medical Evaluator: a physician appointed by the Administrative Director to evaluate disputed medical issues (8 CCR §49(g); Labor Code §139.2).
R
- Reappointment (QME)
- A QME's renewal of appointment. It may be denied on grounds including missing evaluation deadlines on three or more occasions in a calendar year or more than 120 days of unavailability in a year (8 CCR §51).
- Recording consent
- California generally requires the consent of all parties to record a confidential conversation (Penal Code §632). OM records a visit only after the patient's verbal consent is captured.
- Records production
- A set of a patient's records copied and delivered in response to a subpoena or request. OM builds it as a Bates-numbered, attested PDF or ZIP with a one-time delivery link.
- Reopening
- A worker may seek further compensation for new and further disability within five years of the date of injury (Labor Code §5410).
- Represented / unrepresented
- Whether the injured worker has an attorney. Many QME rules, forms and deadlines differ on this point.
- RFA (DWC Form RFA)
- The Request for Authorization (DWC Form RFA): the state form a treating physician uses to ask the claims administrator to authorize a specific course of treatment (8 CCR §9792.6.1(u)).
- Rights request
- A patient's request to exercise a privacy right, such as access to or amendment of their records. OM tracks each one and its deadline.
- RTW
- Return to work, to regular, modified or alternative duty.
S
- SBR / SBR-1
- Second Bill Review: the provider's request that the claims administrator reconsider a bill. It is due within 90 days of service of the EOR (Labor Code §4603.2(e)(1) for treatment; Labor Code §4622 for med-legal). SBR-1 is the DWC request form.
- Service-by-mail extension
- Extra days added to a deadline when the triggering document was served by mail: 5 within California, 10 elsewhere in the United States, 20 outside it (8 CCR §10605(a)).
- Settlement
- The resolution of a claim by agreement. OM records a settlement notice and, for personal injury, ties the settlement amount to the lien balance.
- SJDB
- The supplemental job displacement benefit: a voucher for retraining or skill enhancement when the employer does not offer suitable work after a permanent partial disability (Labor Code §4658.7).
- Strike
- In a represented case, each party may strike one name from a three-QME panel within 10 days of its assignment (Labor Code §4062.2(c)).
- Sub rosa
- Covert surveillance video of the worker, usually obtained by the defense. A physician's review of it is billed under ML205.
- Substantial evidence
- The standard a medical report must meet to be relied on: its conclusions must rest on reasoned explanation from the facts, not bare conclusions. Chiron reviews opposing reports for gaps against it.
- Summary rating
- A DEU permanent disability rating calculated from an evaluator's or treating physician's report on an unrepresented case (8 CCR §10160).
- Supplemental report
- A med-legal report that does not involve a new examination, written after new records or a party's request (8 CCR §9793(m)). It is due within 60 days of the request (8 CCR §38(i)) and billed under ML203.
T
- TD
- Temporary disability: wage-loss payments while the worker recovers. The first payment is due within 14 days after the employer knows of the injury and disability (Labor Code §4650(a)).
- Telehealth (QME)
- A medical-legal evaluation done remotely, permitted only within the limits of 8 CCR §46.3. OM tracks each evaluator's telehealth eligibility.
- Therapy visit limit
- A worker is entitled to no more than 24 chiropractic, 24 occupational therapy and 24 physical therapy visits per industrial injury unless the employer authorizes more in writing (Labor Code §4604.5).
U
- UR
- Utilization review: the claims administrator's review of a treatment request, approving, modifying or denying it based on medical necessity (Labor Code §4610(a)).
- UR timeframes
- Five business days for a prospective or concurrent request, 30 days for a retrospective one, and 72 hours for an expedited one, where the worker faces an imminent and serious threat to health (Labor Code §4610).
V
- Vázquez factors
- The good-cause factors OM applies when a panel QME cannot be scheduled in time: diligence of efforts, length of delay, reasons for delay, prejudice to the parties and availability of alternatives. Chiron summarizes the recorded history against them; the decision is not Chiron's.
W
- Waddell signs
- Five categories of non-organic physical signs in low back examination. OM's PM&R exam summary reports the count.
- WCAB
- The Workers' Compensation Appeals Board, which decides disputes in California workers' compensation cases.
- Work restrictions
- The physician's limits on what the worker may do at work. You record them once with dates, and Chiron carries them to every form and letter.
- Work status
- Whether the worker is off work, on modified duty or at full duty, with dates. A PR-2 cannot go out without a work-status date.
- WPI
- Whole person impairment: a physician's measure of permanent loss of function, as a percentage of the whole person under the AMA Guides (Labor Code §4660.1(b)).
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