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What happens if your employer claims your injury isn’t from work?

On Behalf of | May 3, 2022 | Workers' Compensation |

Every worker in California can rely on workers’ compensation if they get hurt on the job or their doctor diagnoses them with a medical condition caused by work. Whether a worker is full-time or part-time, whether they make a salary or an hourly wage, and whether they just started the job or have been there for 20 years, workers’ compensation protects them.

Unfortunately, some workers who need those benefits face a denied claim and then pushback from their employer who claims that they didn’t get hurt on the job. What rights and options do you have if your employer tries to defend against your workers’ compensation claim by alleging that your condition is not a result of the work that you do?

You can contest their allegations

If your employer alleges that your injury occurred outside of work, you can gather medical evidence to show that your job is the cause of your injury. California certifies some medical professionals as qualified medical examiners (QMEs) to help with workers’ compensation claims.

When there is a dispute about the origin of a worker’s medical condition, either they or their employer can request a panel QME. The Division of Workers’ Compensation will provide the worker with a list of three random QMEs capable of providing them with an exam. The worker will have to choose someone from that list, even if there is a long drive involved. Workers’ compensation can reimburse people for their mileage and time traveling to such appointments.

After a thorough medical examination, the QME can help establish the connection between an injury and someone’s job responsibilities. Their report will then determine the next steps the worker must take to get benefits.

Workers have rights after a denied claim

Your employer cannot make unilateral decisions about workers’ compensation. You have the right to challenge their decisions and provide evidence to support your claim. Of course, you have to understand your rights in order to stand up for them when your employer wants to deny you workers’ compensation coverage.

Learning about how California handles workers’ compensation claims will facilitate better management of your claim.