Worker, Employer, Attorney, Insurer.
California employers should be prepared to address the psychological and emotional impact employees will have on their business. Hiring practices in sensitive positions, such as education and law enforcement, should include a “Fitness for Duty” evaluation. In addition, an evaluation should take place when employee behavior issues are raised. These are good preventive practices to consider. Otherwise psychological fitness issues of an employee may result in a workers compensation complaint at a later date.
The law requires California employers to carry Workers’ Compensation insurance. If employees are hurt or get sick because of work-related activity, they are paid by Workers’ Comp insurance for any of the following benefits: medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits or vocational rehabilitation and death benefits.
Evidence-based medical treatments provided by doctors in California’s workers’ compensation system provide scientifically proven cures or relief for work-related injuries and illnesses. The state provides a set of treatment guidelines practitioners follow for specific injuries, including how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
An employer might contest a workers’ compensation claim over issues such as whether the injury was sustained on-the-job or how much in benefits should be paid, a dispute may require the assistance of an attorney specializing in this area.
When the claim administrator for the employer disagrees with the physician report regarding the employee’s injury or treatment, the next step is to contact a Qualified Medical Evaluator (QME). The QME is a physician who meets additional educational and licensing requirements, and is able to evaluate the recommended treatment and adjudicate the compensation issues. If the claimant’s attorney and the employer’s claims administrator agree on a qualified doctor to resolve medical disputes, this doctor is called an Agreed Medical evaluator (AME).