Workers’ compensation is not optional, not negotiable, and not a favor from your employer.
It is governed by state law, reinforced by federal protections, and only implemented by your employer.
If something feels off, confusing, delayed, or punitive — you’re probably right to question it.
This page exists to explain:
- what workers’ comp actually is
- who controls what
- what employers can and cannot do
- how to protect yourself when the process breaks
Who Actually Has Authority (Read This First)
Authority does not start with your department.
It flows top → down:
STATE LAW
California Workers’ Compensation Act
Controls the claim, pay, and medical process
FEDERAL LAW
ADA • FEHA • FMLA
Controls employer behavior and accommodations
UNION CONTRACT
AFSCME 3299 SX
Adds protections and limits discipline
EMPLOYER POLICY
Implementation only — cannot override law or contract
DEPARTMENT PRACTICE
Lowest authority — no independent power
Authority flows downward. Rights flow upward.
What This Means in Real Life
No employer, manager, or HR administrator gets to:
- reinterpret medical restrictions
- delay pay as “leverage”
- condition accommodations on unrelated compliance
- punish you for using workers’ comp
- reframe system failures as employee misconduct
If they do — that’s not policy.
That’s a violation.
What Employers ARE Allowed to Do
Yes, employers are allowed to take certain actions — but only within legal guardrails.
An employer MAY:
- Require medical certification from a licensed provider
- Request clarification of work restrictions (not reinterpret them)
- Engage in the interactive process
- Offer reasonable accommodations
- Schedule interactive process meetings with reasonable notice
- Place an employee off work only if no safe work exists within restrictions
Allowed does not mean unlimited.
What Employers Are NOT Allowed to Do
These actions are not “policy disagreements.” They are violations.
An employer may NOT:
- Override or reinterpret medical restrictions
- Reclassify an industrial injury as non-industrial without medical evidence
- Delay pay as pressure or leverage
- Punish workers’ comp–related absences
- Weaponize the interactive process
Temporary changes to job tasks to keep work within medical restrictions.
Modified duty must:
- follow restrictions exactly
- avoid aggravating the injury
- be legitimate work
Why it matters:
Working outside restrictions can harm your health and your claim.
Definition:
A QME is a state-certified doctor who provides an independent medical opinion in a workers’ compensation case when there is a dispute about diagnosis, work-relatedness, restrictions, or disability status.
Why it matters:
QMEs influence major decisions about benefits, work status, and permanent disability ratings.
Definition:
The claims examiner (also called claims administrator) is the person assigned by the workers’ compensation carrier to manage the claim, issue benefit payments, and authorize or deny treatment.
Why it matters:
They control approvals and payments, but must follow workers’ compensation law—not employer preference.
Definition:
Sedgwick is a third-party administrator hired to manage workers’ compensation claims on the employer’s behalf.
What they do:
• administer WC claims
• issue TD payments
• coordinate medical authorizations
What they do NOT do:
• decide accommodations
• discipline employees
• override medical restrictions
Adjustments that allow you to work safely, such as:
- task modifications
- schedule changes
- equipment
- alternative assignments
Accommodations must be reasonable and medically appropriate.
Why it matters:
Accommodations cannot require you to violate medical restrictions.
An injury or illness caused by your job or work duties.
This includes:
- One-time accidents
- Repetitive motion
- Exposure
- Aggravation of a pre-existing condition
👉 Covered under workers’ compensation.
A condition not caused by work.
Employers cannot reclassify an injury as non-industrial without medical evidence.
➡️ Misclassification = medical interference.
An injury that develops over time due to repeated job duties (lifting, bending, standing, stress, exposure).
These are fully valid WC claims — even if there was no single accident date.
A required, good-faith dialogue between employer and employee when medical restrictions exist.
Purpose:
To identify reasonable accommodations so the employee can work safely.
Who should attend:
- The employee
- Employer/HR representative
- Disability management or accommodations unit
- Union rep (recommended)
➡️ This is not disciplinary and not optional.
A formal meeting to discuss:
- Medical restrictions
- Essential job functions
- Possible accommodations or modified work
The employer cannot weaponize this meeting or condition accommodations on unrelated compliance.
A state-certified independent doctor who resolves medical disputes in workers’ comp cases.
QME opinions can affect:
- Injury classification
- Disability ratings
- Work restrictions
- Permanent disability
A medical percentage assigned to reflect loss of function.
Used to calculate Permanent Disability (PD).
A factor used to estimate how an injury affects your ability to earn income long-term.
It influences permanent disability calculations.
A medical determination that your condition has stabilized, even if symptoms remain.
- This does not mean: You are healed
- You can work without restrictions
- It means your condition is unlikely to significantly change
Core job duties that are fundamental to a position.
Employers often misuse this term to deny accommodations — but they must prove necessity.
A different assignment offered when regular duties are unsafe.
It must still:
- Follow restrictions
- Be legitimate work
- Not be punitive
Wage replacement when you cannot work due to a work injury.
Common forms:
- TDD – Temporary Total Disability
- TPD – Temporary Partial Disability
- TD is statutory — not discretionary.
Insurance benefits (not WC) that may apply when WC does not or when leave extends long-term.Often administered by third-party insurers like Lincoln Financial.
Compensation for lasting impairment after reaching P&S/MMI.
Calculated using:Impairment rating
FEC
Age and occupation
A voucher for retraining or education if you cannot return to your prior job.
Can cover:
- Tuition
- Books
- Training programs
- Certifications
EVS LIVES MATTER 