Workers’ compensation is a no-fault program that offers protection both to employers by reducing their liability and workers by reducing their personal financial risks. You can claim benefits even if you made a mistake that contributed to your injury. Your employer cannot deny you medical coverage or other benefits just because you have some personal responsibility for what happened.
However, there are other ways for businesses to try to defend against workers’ compensation claims. Claiming that a worker got hurt not on the job but rather on their own time is one possible defense against a workers’ compensation claim.
If your California employer claims that you didn’t get hurt on the job, does that mean that you can’t get benefits?
You can see a specialized doctor when your employer denies responsibility
Workers do sometimes make claims for benefits they don’t deserve, and businesses sometimes try to deny claims that are obviously legitimate. Thankfully, the California workers’ compensation program has rules in place for a scenario where an employer questions the origins of a workplace injury.
If the business denies that the worker claiming benefits got hurt on the job, they can request a panel QME. A QME is it qualified medical examiner or a physician certified by the state whose report will help clarify the origins and impact of the injury.
The worker receives a randomly-generated list that includes the names of three physicians somewhere in the state and can make an appointment for an evaluation with one of them. The random generation of this list helps prevent biases due to a pre-existing relationship between the worker and the medical professional or the medical professional and the employer.
Knowing your rights can make it easier for you to handle a complex workers’ compensation claim in California.