Which Medical Costs Are Covered By Workers’ Compensation?
If you are injured on the job and entitled to workers’ compensation benefits, your employer (or its insurance company) is required by law to provide you medical treatment to address the health problems caused by your injury. This treatment does not have maximum dollar limits, nor does it have deductibles or copayments.
What Would Your Employer Pay For?
Your employer’s responsibility to you includes all things medically necessary to allow for the best treatment possible, including:
- Doctor visits
- Prescriptions
- Therapy
- Laboratory testing
- Nursing care, if required
It may also include durable medical equipment provided to you at no cost, including mobility assistance devices where required. For some severe injuries, it may also include home nursing and modifications of your home or vehicle.
If you require hospitalization and/or surgery for your injury, the insurance company will cover the associated costs. The hospital and the insurance carrier should make payment arrangements in advance to cover your medical needs.
Your expenses incurred for trips to and from medical treatment (parking and mileage) are reimbursable. Therefore, keeping a careful record of your visits to medical professionals and the round-trip mileage is recommended.
The insurance company may also be required to treat other health problems you may have if treatment for those problems is medically necessary to allow for treatment for your injury. Common examples are the treatment for preexisting diabetes or the provision of a weight loss program in anticipation of surgery.
Insurers May Dispute Your Treatment Plan
If the insurance company disputes the recommendations of your primary treating physician, the reports will be submitted to utilization review. This review determines whether the treatment falls within the California Department of Industrial Relations guidelines and whether the treatment is reasonable and necessary.
If the utilization review physician determines that your doctor’s treatment recommendation is not appropriate, you can submit this decision for independent medical review for a second opinion. The insurance company is not required to pay for treatment that has not been preapproved except in extreme emergencies.
You may be required to select your treating physician from a medical provider network (MPN). If there is an MPN, you may change treating doctors within the network whenever you desire. There is a provision for second and even third opinions regarding treatment from within the network itself, should you desire.
According to the law, medical treatment disputes may not normally be heard by a judge. In addition, such disputes may not be determined by a neutral physician unless the parties agree to be bound by their opinion.
Unless you settle your workers’ compensation case by compromise and release, medical treatment continues to be available, as needed, for your lifetime. The lifetime anticipated cost of medical treatment to cure or relieve the effects of your injury may far outweigh the value of projected disability payments. For settlements, the value of the medical treatment must be factored into the settlement amount.
Get The Medical Care You Need To Recover
Your case might not be fully resolved once you file your workers’ compensation claim. You will still face a long road ahead as you heal or adjust to your work-related injury or illness. At my firm, the Law Office of Howard J. Stevens, APC, I am continuously committed to your medical and economic recovery. I am attorney Howard J. Stevens. Allow me to help you secure benefits and stand up to insurers to protect your rights.
For prompt assistance with seeking benefits that may help you afford treatment, call 619-880-4501 or complete this online contact form. I understand how important the recommended medical care is for your well-being. Protect your right to have the medical treatment prescribed.