WORKERS COMPENSATION MEDICAL TREATMENT

If you’ve suffered an on the job injury, you’ve got a lot on your mind. You have to worry about your job. How are you going to continue to get paid while you recover? You have to worry about your health. Will you regain the strength and mobility that you had prior to being injured? Perhaps, most of all, you have to worry about receiving the medical treatments that you need in order to regain that strength and mobility. How will you get the treatment that you deserve and who will pay for that treatment?

The last thing that you need at such a difficult time as this is additional worries. You need to be able to rest and rehabilitate with a clear mind so that you are back on your feet as quickly as possible. The attorneys at the law firm of Fraulob-Brown can give you the peace of mind you need and deserve. They are experts in all aspects of California’s workers' compensation laws, including an employee’s rights to medical treatment for an on-the-job injury. They are here to answer all your questions about medical treatment, eliminating the worries that may be weighing you down. More importantly, they will use the law to get you the necessary medical treatments that you need to make you whole again.

AM I ENTITLED TO MEDICAL TREATMENT FOR MY INJURIES?

The answer to this question is a resounding yes. All workers' compensation laws, including California’s, were put into place to protect injured workers. They were a direct response to the then existing situation which left a worker who had been injured in an on-the-job accident out in the cold. Back then, an injured worker was unable to earn a living. Without a paycheck, the worker could not afford to pay for the medical treatments that would allow him or her to recover. Without recovery, the worker couldn’t return to work. It was a vicious circle.

This is why California’s workers' compensation laws require that an injured worker receive all medical treatment that is reasonably required to treat or cure an injury. If you were injured on the job, you have a right to receive treatment for your injuries. However, like all rights, your right to medical treatment for a work related injury can be unfairly impinged. A competent workers' compensation attorney, like those at the law office of Fraulob-Brown, can help protect your right to treatment.

WHAT TYPES OF MEDICAL TREATMENT AM I ENTITLED TO?

It is the responsibility of the physician who is treating you for your work related injuries to prescribe the reasonable care that will allow you to recover. By law, in order to be reasonable, this care must follow scientifically based medical treatment guidelines that are published by the State of California. Your physician will most likely use these guidelines when deciding on your course of treatment.

The treatment guidelines not only outline reasonable treatments, they also provides recommendations as to how often a given procedure or therapy should occur and how long it should last. As long as your prescribed treatment falls within the guidelines, you can be reasonably assured that you will receive the type of treatment that you need to recover.

Sometimes, however, your physician will prescribe a treatment that is not contained within the guidelines or will want a treatment that is contained within the guidelines to occur more frequently than recommended. In these cases, your physician is required to present evidence to the claims administrator in charge of your case that the treatment in question follows other scientifically based guidelines that are recognized by the medical community at large.

When you are injured, you want to make sure that you have access to all the available treatments that can bring you back to the peak of health. The attorneys at the law office of Fraulob-Brown have the workers' compensation experience necessary to ensure that you receive the medical treatments that your doctor has prescribed for you.

WHO WILL PAY FOR MY MEDICAL TREATMENT?

Your employer either pays into a workers' compensation insurance policy or is self-insured. This policy is in place to pay for the medical expenses associated with a work related injury. Once you have established a valid workers' compensation claim for your work related injuries, the claims administrator will pay your medical bills out of funds provided by your employer’s insurer. You will never see a single bill. In fact, in California it is illegal for any medical provider to bill a patient if they know an injury is, or may be, work related.

In fact, you are able to receive limited payment for your medical bills even before your workers' compensation claim has been accepted. By law, the claims administrator assigned to your claim is required to authorize medical treatment up to $10,000 within one day of the filing of your workers' compensation claim.

However, the insurer can object to making a payment if they feel the treatment in question was not reasonable and/or did not follow scientifically based medical treatment guidelines. In such a case, the treatment is subject to a process known as Utilization Review. Under Utilization Review, your doctor’s treatment plan is reviewed by a third party doctor hired by the claims administrator handling your claim. This third party doctor will make a determination whether the treatment is reasonable and follows the treatment guidelines. If it is determined that the treatment is reasonable, then the insurer is required to pay for the treatment in question.

If your treatment was denied by the third party doctor during Utilization Review, you have the right to appeal that decision through an additional process known as Independent Medical Review. During Independent Medical Review, your doctor’s treatment plan is again reviewed by a physician, this time one with no ties to you, the insurer or the claims administrator. If this doctor finds that the treatment in question is reasonable, the insurer again is required to make payment.

As you can see, the process of obtaining appropriate treatment for an on-the-job injury, as well as obtaining payment for that treatment, can be complicated. Don’t trust your health and finances to chance. The attorneys at the law office of Fraulob-Brown have the experience necessary to make sure that you get the medical treatment you need and to get the bills for that treatment paid.