If you are hurt at work, your employer must provide you with all treatment reasonably necessary to cure or relieve from the effects of your injury. Your employer is required to provide this medical treatment at no cost to you. To qualify for medical treatment, your injury must arise out of your employment and occur in the course of your employment. That’s a legal way of saying that your injury must be linked to your job. If you aren’t sure whether your injury is sufficiently linked to your job, you should consult a workers’ compensation attorney as this is a complicated area of the law where small facts can make a big difference. You must also be an employee and not an independent contractor.
How do I get medical treatment for my work injury?
In order to trigger your employer’s obligation to provide medical treatment you must report your injury to your supervisor as soon as possible. Once your employer has knowledge of your injury (either through your report or any other means) they must provide you with a claim form and notify you of your right to workers’ compensation benefits, including medical treatment. Filling out the claim form starts your workers’ compensation claim. Your employer’s workers’ compensation insurance company then has 90 days to either accept or deny your claim. During the 90 day period while the insurance company determines whether or not to accept your claim, they must provide you with medical treatment up to a $10,000 cap.
Can I go to any Doctor for my Medical Treatment?
Generally speaking, you do not get to pick any Doctor you want. These days, most workers compensation insurance companies have a Medical Provider Network (MPN) with several doctors who practice in various specialties. Your first trip to the doctor will always be to the company doctor who is a member of the MPN. You can avoid treating in the MPN if you predesignate your primary treating physician (PTP) and that physician accepts you as a patient. Your HR department should give you the pre-designation form when you start your employment. You can also find it here: https://www.dir.ca.gov/dwc/FORMS/DWCForm_9783.pdf It is always to your advantage to treat with the best PTP available.
What kind of medical treatment do I get?
Your medical treatment is limited to treatment that is reasonably necessary to cure or relieve the effects of an industrial injury. Which begs the question: what is reasonably necessary? In California, the Medical Treatment Utilization Schedule or MTUS provides guidance. Essentially, the MTUS attempts to list all medical issues a person might encounter and then list appropriate treatment for each condition. Your PTP will diagnose your condition and then request authorization for treatment which will be reviewed by another doctor in the Utilization Review process. (UR will be the next blog topic, link this post to that post).