“Administrator” means the appointed agency(s) responsible for managing claims under this chapter. Managing claims includes the duties set forth in Section 12-109.

“Arise out of employment” or “arising out of employment” means an incident giving rise to occupational injury or illness that is causally related to the conditions and obligations of employment.

“Benefits” mean those workers’ compensation benefits to which an employee is entitled under Section 12-111.

“Casino” means the Sky River Casino, or any other casino owned and operated by the Wilton Rancheria Gaming Authority, a governmental subdivision of the Tribe (“authority”) under a tribal-state gaming compact with the state of California.

“Child” or “children” means the offspring of an employee, and shall also include an unborn child, a child legally adopted prior to the compensable injury, a child toward whom the employee stands in loco parentis, and a stepchild if such stepchild was, at the time of the injury, a member of the employee’s family and household, and substantially dependent upon the employee for support. “Child” also includes any person deemed to be an employee’s child under tribal custom, as interpreted by the Tribal Council or its appointed representative.

A child will remain eligible for death benefits if and so long as:

“Claim” means claim for benefits by a casino employee or dependent under this chapter for a compensable injury.

“Claimant” means an employee or qualified dependent who, complying with the procedures established in this chapter, submits a claim under this chapter, and who is determined to have sustained a compensable injury.

“Compensable injury” means a specific (resulting from one (1) incident or exposure) or cumulative (resulting from repetitive or continuous activity or exposure) injury, illness, or condition, including damage to artificial limbs, dentures, hearing aids, eyeglasses, and medical braces of all types (provided, that such damage is incidental to an injury), where such injury, illness, or condition meets the standards set forth in Section 12-110. Where the primary injury, illness, or condition meets the standards set forth in Section 12-110, consequential injuries alleged to be attributed to the compensable injury will be compensable only where there is objective medical evidence submitted by a physician or other medical professional approved by the Administrator that directly correlates such a consequence to the original compensable injury, and where there is no intervening or superseding event.

“Course of employment” means taking place within the period of employment, at a place where the employee is reasonably expected to be under the terms of his or her employment, and while fulfilling his or her occupational duties or engaging in an activity incidental thereto. Injuries sustained in transit to or from work are not deemed to have occurred during the course of employment unless the journey itself is part of the employee’s occupational duties and there was no substantial deviation from those duties.

“Days” means calendar days unless otherwise specified.

“Death benefits” means funeral expenses and monetary compensation provided to a deceased employee’s dependents where the employee’s death is the direct result of a compensable injury.

“Dependent(s)” means the spouse and/or child or children of the deceased employee. Tribal custom may allow for the extension of dependency status to other family members if such family members were wholly dependent upon the deceased employee at the time of death. Extending the status of dependent to persons other than a spouse or child is within the Administrator’s discretion, subject to approval by the Tribe.

“Employee” means a person employed by the casino or in service of the casino, under any contract of hire, express or implied, oral or written, under which such individual receives a salary or wages for work performed for the casino. “Employee” shall not include any person who qualifies as an independent contractor, contractor, outside consultant, or volunteer.

“Idiopathic injury” means an injury to an employee that arises spontaneously from an unknown or obscure etiology or cause, or a risk or injury that is peculiar to the employee, the cause of which is precipitated not by an event that can be causally linked to employment specifically, but rather an activity of daily living.

“Independent medical examination” means an evaluation by a physician, who is either on the state of California list of approved independent medical reviewers or the state of California list of approved qualified medical evaluators, or is an agreed medical examiner (via mutual agreement of the casino and the employee), performed in order to determine causation, extent, medical status, work status, permanent and stationary status, level of impairment, entitlement to benefits, apportionment, or other similar attribute of an injury, illness, or condition. An independent medical examination shall be conducted upon request of the Administrator at the expense of the casino in order to resolve a medical dispute.

“Permanent partial impairment” means a level of permanent disability at the time a permanent and stationary status (“P&S”) and/or maximum medical improvement (“MMI”) is achieved, as opined by a treating physician or as the result of an independent medical examination using the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, which results in a whole person impairment rating of less than seventy percent (70%).

“Permanent total impairment” means a level of permanent disability at the time a P&S and/or MMI is achieved, as opined by a treating physician or as the result of an independent medical examination using the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, which results in a whole person impairment rating of seventy percent (70%) or higher. There shall be no presumptions of permanent total impairment under this chapter.

“Psychiatric injury” means a mental disorder diagnosed pursuant to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which is medically attributable to employment by a preponderance of evidence, and which resulted in its entirety from a specific, traumatic employment event.

“Reservation” means all those lands within the exterior boundaries of the Wilton Rancheria, and such other lands as hereafter may be acquired by the Tribe or by the United States of America for the Tribe’s benefit.

“Spouse” means the legally ordained husband, wife, or domestic partner of the employee; however, a domestic partner will only be considered a spouse under this chapter if, at the time of the compensable injury, the employee and said domestic partner cohabitated and were registered with the California Secretary of State’s Domestic Partners Registry.

“Temporary partial disability” means a nonpermanent medical status that results in the employee being restricted to modified or light work duties or reduced hours at the direction of, or as opined by, a physician approved by the Administrator, which results in diminished earnings when compared with the employee’s preinjury average weekly wage.

“Temporary total disability” means a nonpermanent medical status that results in the employee being physically unable to perform any work at the direction of or as opined by a physician approved by the Administrator, which results in a complete loss of earnings.

“Tribal Council” means the elected governing body of the Tribe exercising authority pursuant to the Tribe’s Constitution.

“Tribal Court” means the Wilton Rancheria Tribal Court, or any other entity explicitly designated by the Tribe to serve in that capacity for purposes of this chapter.

“Tribe” means the Wilton Rancheria, a federally recognized sovereign nation, including the Wilton Rancheria Gaming Authority, and all incorporated and/or unincorporated Tribal Governmental authorities and entities. For purposes of the definitions used in this chapter, the term “Tribe” does not include the entities included in the definition of “casino.”

“Vocational rehabilitation” means the amount payable to a claimant who sustains permanent partial impairment as the result of a compensable injury, and who does not receive a bona fide offer of permanent modified or alternative work from the employer, to help compensate that claimant for the anticipated costs of vocational retraining or rehabilitation in order to return to gainful employment.

“Written decision” means any of the following, when reduced to writing and sent to a claimant: