Every employer in California has to protect its workers by carrying workers’ compensation insurance. If someone gets hurt on the job or develops a work-acquired injury, the employee affected can receive medical benefits and disability benefits.
Workers’ compensation can help even those with employer-sponsored insurance because the worker won’t have to cover any co-pay, co-insurance or deductible costs. Additionally, if the medical issue results in a protracted leave of absence, the worker can count on disability benefits to cover at least part of the wages they are unable to earn.
Unfortunately, some workers who need workers’ compensation will find their claim denied or delayed because their employer insists that they did not get hurt on the job. What happens then?
The state will help validate the nature of the injury
When your employer insists that your medical condition isn’t work-related, you may need to reach out to the Division of Workers’ Compensation, which is part of the California Department of Industrial Relations.
In the event of a dispute between a worker who claims they deserve benefits and an employer who denies that the workplace contributed to the injury, the worker may have to undergo an examination via panel Qualified Medical Evaluator (QME). The worker receives a list of three QMEs approved to perform such exams.
The use of randomly generated lists helps reduce the risk of a conflict of interests impacting what benefits a worker receives. Unfortunately, this may mean that the claimant will have to travel some distance to attend an appointment with a QME from the panel provided.
The QME will perform an examination to determine the cause of the injury and whether or not it truly relates to someone’s job. Their decision and report will then have a direct impact on any benefit claim brought by the worker.
How can you advocate for yourself during this process?
When your employer tries to deny that you got hurt on the job, there are certain things you can do to help protect yourself. These include making a written list of the people who witnessed the injury and the details of when it happened and what occurred.
It’s also important to advocate for yourself during the appointment with the QME. Explaining how you perform your job and what exactly led to your injury can help the physician involved connect your condition with your job responsibilities. Knowing your rights during a workers’ compensation claim and help you if complications arise.