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What if an employer claims a worker’s injury occurred elsewhere?

On Behalf of | Feb 15, 2024 | workers' compensation

Employees with a job-related health issue can usually count on California workers’ compensation to address some of their related needs. The law extends numerous forms of protection to those injured while performing a job. California employers must provide workers’ compensation insurance coverage for employees regardless of how long they have held the position or their part-time status.

Employees who get hurt at work could request disability and health coverage benefits. They could also request accommodations that can help them return to work safely. However, employers are not always supportive of those who require benefits because of job-related health issues. Companies may not want to provide accommodations or may worry about rising premium costs.

Sometimes, there could be allegations that a worker faked their condition, exaggerated their symptoms or blamed their job for a health issue caused by something else, like a hobby. What happens if employers try to claim that a worker didn’t get hurt on the job?

The worker may need to attend an evaluation

The Division of Workers’ Compensation (DWC) is part of the State of California Department of Industrial Relations. The DWC plays an active role in enforcing workers’ compensation rules and settling disputes between businesses and employees.

The solution for workers’ compensation disputes is often professional medical support. Physicians can evaluate someone’s condition thoroughly to determine if they have exaggerated their symptoms or falsified their claims. Physicians can quantify the extent of someone’s injury and the impact it might have on their functional abilities. They can also reach certain conclusions about the likely origin of someone’s injury.

The DWC can require that someone seeking workers’ compensation benefits undergo a specialized examination performed by a qualified medical evaluator (QME). The report generated by a QME can help resolve any conflicts about the origin of someone’s condition, the need for treatment and what, if any, accommodations they require to continue working.

Even when there is a disagreement about someone’s eligibility for workers’ compensation benefits, California has systems in place to help protect those who truly need assistance. Learning more about the different rules and requirements for workers’ compensation claims, and seeking legal guidance accordingly, may help people secure the benefits they deserve.


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