Workers Comp medical benefits in California are provided to any employee injured on the job so long as the medical treatment is reasonably necessary to cure or relieve your work injury.
If an employer does not provide that care when appropriate, he will need to reimburse the employee for the employee’s reasonable medical expenses. An employee is not required to pay any medical bills for a work related injury so long as he fills out the required form and reports his injury to his employer. (Bell v Samaritan Medical Clinic (1978).
The term “reasonably required” is a weasel term and employers or their insurers often try to dodge expenses of care by alleging that the treatment was not reasonably required.
If a medical provider receives a notice that the employer rejects liability for an injury, the medical provider must give such notice to the employee. If he doesn’t give such notice to the employee, he or she cannot bill the employee. If they do, such provided may be subject to a penalty of triple what they bill the employee.
Note, however, that an injured employee can make his own arrangements for consulting or attending physicians at his own expense.
There are guidelines for medical treatment called Medical Treatment Utilization Schedules which are recommended guidelines for treatment. They are presumed correct as to the scope and extent of treatment BUT, this is a presumption that can be rebutted.
The Medical Treatment Utilization Schedule (MTUS) is organized by body part:
Neck and Upper Back
Elbow
Shoulders
Forearm, Wrist and Hand
Low Back
Knee
Ankle and Feet
Stress Related Conditions
Eyes
If an injury is not designated above, it can still be treated in accordance with evidene based medical treatment.
If an employee’s pain persists beyond the anticipated time for healing, chronic pain medical guidelines apply.
If surgery becomes necessary, there are also guidelines for surgical and post surgical care.
There are also so called “Special topics” that occur in the guidelines. These guide treatment by
Acupuncture
Chronic Pain
Postsurgical treatment.
Many employers maintain control of the employees medical treatment by means of a medical provider network or MPN.
After 30 days, however, an employee can treat with a qualified doctor of his choice in the same geographic area.
An employee can only have one primary treating doctor.
An employee IS allowed to pre-designate his primary treating doctor if he or she has medical coverage outside of his work and notifies the employer in advance.
That primary doctor can refer to other doctors in the nonregulated health plan if necessary.
Finally, if an employee redesignates a personal chiropractor who is his regular chiropractor, he can be treated by that chiropractor after he goes to the employers selected doctor the first time.
I’m Ed Smith, a Sacramento Workers Comp lawyer. My main site is www.AutoAccident.com. Call me anytime for free, friendly advice at 916-921-6400 or 800-404-5400.
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