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Know Your Rights to Medical Treatment for Work-Related Injuries (Regardless of Date of Injury)

As of July 1, 2013, medical treatment for a work-related injury will be controlled by your employer more than ever before. With the passing of Senate Bill (SB) 863, California’s latest Workers’ Compensation “reform” (effective January 1, 2013), new deadlines must be adhered to and treatment requests will be scrutinized heavily. Mistakes and omissions give insurance companies the justification they need to deny a request for medical care.   

The attorneys at Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP (GEK) are at the forefront in educating doctors and others in the community about these changes in the law, and continue to participate in reviewing statewide regulations implementing these new changes.   It is with this expertise that we suggest the following ways to help ensure that you receive the medical care you need, and what you can expect may happen along the way:

  • In order to receive medical treatment, you must file a Workers’ Compensation Claim Form. You are entitled to medical treatment within 24 hours of reporting an injury.
  • If you have properly pre-designated your own doctor (must be done in writing before an injury), you may be treated by that physician from the date of injury until treatment is concluded.
  • If you have not pre-designated a doctor, and if your employer provides Workers’ Compensation medical care through a Medical Provider Network (MPN), you must select a treating doctor from the network’s approved provider list. The doctor chosen from this list could have a significant impact on your case. If your employer doesn’t participate in the MPN, you may select any doctor (who is willing to provide medical care in the Workers’ Compensation system) after 30 days from the employer’s receipt of your Workers’ Compensation Claim Form.
  • It is critical that your doctor has a clear understanding of the Workers’ Compensation laws and understands the reporting requirements and the process necessary to request medical treatment. 
  • The treating physician must request medical treatment by using a specific Request for Authorization Form. This form must be completed to the last detail or it will be returned as “incomplete.”
  • Treatment requests are subject to Utilization Review (UR), a process in which insurance companies can approve, delay, modify or deny treatment. If the request is not approved, you have only 30 days from the date of the UR decision to request an Independent Medical Review (IMR) of the decision. The IMR will be conducted by an IMR organization designated by the California Department of Insurance. Following July 1, 2013, this is true for all Workers’ Compensation cases, regardless of date of injury. 
  • There are new home healthcare limitations involving service provider requirements, prescriptions, fee schedules, reporting requirements and payment for services.
  • Keep in mind that you may also be entitled to medical treatment for “consequences” of your injury, including internal medical and/or emotional symptoms or complaints.

Obtaining the correct medical treatment for your workplace injury or illness is vital to your health and well-being, and that of your family. With all of the changes stemming from SB 863, it is more important than ever to enlist the help of an experienced, knowledgeable Workers’ Compensation lawyer if you are injured on the job. You need someone who can assist in selecting a doctor that fits your needs, and can help should medical treatment disputes arise. 

GEK’s Workers’ Compensation attorneys have more than 30 years’ experienced fighting for—and winning—Justice for the Injured®. If you would like to speak with a GEK attorney, please click here or call 213-739-7000.

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