What a California worker gets hurt on the job, they can file a claim for workers’ compensation benefits. This important system protects workers from financial losses if they get hurt on the job. Workers receive not only full medical coverage for work-acquired medical conditions but also potentially disability benefits if they are unable to work while undergoing treatment for their conditions.
Applying for workers’ compensation is a typically straightforward process. An employee notifies their employer about their condition and then coordinates medical care and possibly a leave of absence. Unfortunately, sometimes, there will be a dispute between the worker and their employer.
What happens if the company claims that a worker did not suffer their injury on the job but that it is an outside and unrelated medical issue?
The state has a special process for resolving such disputes
The Division of Workers’ Compensation (DWC) is the California state agency that oversees the workers’ compensation benefits program. If there is a significant dispute between a worker and their employer, the DWC may intervene.
For example, when a worker claims benefits for their employees are alleges that their injury was not because of their job, the worker may need to ask the state for assistance. California tests and certifies certain medical professionals as qualified medical examiners (QMEs). These professionals can play an important role in a workers’ compensation claim.
During a dispute between a worker and their employer about the origin of certain injuries, the state can provide a panel QME. They will give the worker a list of three random QMEs for the worker to choose from. The employee will have to undergo extensive testing, and the report submitted by the QME will help clarify whether the evidence supports the assertion that the worker’s job cause the medical condition.
Workers facing a disputed claim may need help
Making sense of the workers’ compensation claims process is not particularly easy to begin with, and it can become much harder when there is a dispute about how someone suffered an injury or the impact that injury has on their work functions.
Knowing your rights and understanding the sometimes complicated workers’ compensation claims process can help you get the benefits you need.