Some workers’ compensation claims are very simple. An individual gets hurt at work, notifies their supervisor, and leaves immediately to undergo treatment. They file a benefits claim to cover their medical care costs and to help them pay their cost-of-living expenses until they can return to work.
Although the disability benefits available through workers’ compensation will typically leave someone with a gap in their budget, as the state does not fully replace a worker’s wages, those benefits are better than living without income until someone’s condition improves. Medical coverage is also very valuable, as workers don’t have to help pay for their treatment. Sometimes, claims become a bit more complicated, especially if employers and workers don’t fully agree on the details of the situation.
A qualified medical evaluator (QME) is a state-authorized professional with a medical license who can help resolve disputes about a worker’s compensation claim. These are two of the most common scenarios in which a QME ultimately plays a role in the claims process.
When employers doubt the origin of an injury
If someone hurts their knee or their back at work, their employer could potentially claim that the injury occurred elsewhere. When there are disagreements about what caused a worker’s injury, a QME’s evaluation can be very valuable. They can help establish whether or not an individual’s condition likely resulted from their employment. Their report after evaluating the worker can potentially pave the way for someone moving forward with a claim despite a prior dispute by their employer.
When there is a disagreement about returning to work
Getting back to work after an extended leave of absence is often exactly what the injured employee wants. They want their income to go back to normal and to feel like a productive member of society again. However, if people return to work too soon before they have healed or at least gotten their symptoms under control, their condition may worsen. When an employer or possibly the physician overseeing someone’s treatment indicates that they should return to work but the employee does not agree, a QME can provide clarity regarding whether someone can return to work and what accommodations they would require to do so.
Making use of the systems in place for the protection of workers, such as evaluations performed by a QME, may help those hurt because of their employment get the benefits that they need and deserve.