Being injured on the job is no small thing. An individual may experience significant pain, incur a massive amount of medical debt and face the challenges imposed upon them by lost wages. Fortunately, workers' compensation benefits are available to most of these Californians who have been hurt in a workplace accident. There are some people, though, whose claims are denied for a variety of reasons. There may be disagreement about whether the accident occurred while the worker was performing his job duties, or about whether the claim was filed in a timely fashion. Yet, one of the most common reasons workers' compensation claims are denied is because the injury is not serious enough to keep the individual out of work. This can affect not only an initial claim, but also the amount of benefits received.
This issue often arises when an injured worker's medical professional has a different view on the injuries than the administrator handling the workers' compensation claim. When this happens and a question is raised as to whether the injury qualifies for workers' compensation, a qualified medical evaluator may be appointed to the case. The QME then analyzes the case and makes a final determination.