Medical Treatment for a Workers' Compensation Claim
Follow Protocol…and Document Everything
On-the-job injuries can happen at any time. They can be caused by a specific event, such as falling down stairs, or over time (continuous trauma), such as with carpal tunnel problems.
If you suffer a workplace injury or illness, it is imperative that you notify your supervisor immediately, regardless of the nature or the severity. Also, you should request an Employee's Claim for Workers' Compensation Benefits form from your employer. Fill out the Employee section of the claim form completely, listing all of the effected body parts. Be sure to keep a copy of the form for your records.
Within 14 days of receiving the Claim Form, your employer must accept, reject or delay a decision regarding the industrial injury claim. If the claim is put on delay, your employer has 90 days to determine whether to accept the claim. During this delay period, your employer must provide up to $10,000 worth of medical care to you, the injured worker.
Take Control of Your Medical Treatment
One of the most important issues during the beginning stages of a Workers' Compensation claim is deciding when and where to begin medical treatment. The employer is legally entitled to choose the medical provider for the first appointment. However, you are not obligated to continue treating with this initial physician.
It is the employer's duty to notify the injured worker of the existence of what is known as a Medical Provider Network (MPN), which is a list of preapproved doctors from which an injured worker can choose. Usually, such notification comes in the form of a letter with a website the worker can visit to find a doctor.
An injured worker has an alternative option before complying with this request. Instead, immediately contact an experienced Workers' Compensation attorney who can help you find a different choice instead of blindly picking a random doctor off of a state-issued list.
Keep in mind, however, that if you attend and participate in the state panel QME examination, even an attorney cannot help you in selecting a new and different panel QME doctor and you are stuck with that doctor for the life of your case.
Stop and consider the consequences as the doctor chosen from a QME list could have a significant impact on your case, your future, and your family's future!
Choosing the Right Doctor Is Key
If the claim is not denied within 90 days, an injury will be “presumed compensable,” meaningthat the injury will be accepted.
The medical benefits you're entitled to for your on-the-job injury are based essentially on what the doctor says. Who your doctor is can make a huge difference in terms of the medical treatment you receive and the end result of your case.
What's Included in Medical Treatment
Medical care can include:
- Hearing aids
According to California's Workers' Compensation law, “doctor” encompasses the following:
- Physicians and surgeons
There are stipulations regarding how long certain kinds of professionals can be your primary physician.
Keep a mileage log as Workers' Compensation reimburses injured workers for transportation to and from medical appointments and pharmacies (for approved medical treatment).