Workers Compensation – Medical Treatment
After filing your workers’ compensation claim, the next step is to get proper medical care to recover from your injury. California law requires workers’ compensation claims adjusters to authorize and pay for medical treatment that is appropriate to treat the injury. Designating a primary treating physician is a crucial part of the workers’ compensation process. There are specific rules about who can be your primary treating physician and what medical treatment you can receive, but a Stockton workers’ compensation attorney can help you. There are many steps involved in the medical treatment process for a workers’ compensation claim, but a Stockton workers’ compensation attorney can answer any questions you may have.
What is the role of a primary treating physician?
A primary treating physician’s role is to manage the care of an employee with a work-related injury. The primary treating physician typically has examined an injured worker at least once and has prescribed medical treatment to help the injured employee recover from their injuries. They will refer you to specialists if needed. They will help decide when you can return to work and what kind of work you can do safely while recovering from your injuries. We highly recommend finding a primary treating physician who understands your particular injury or illness because they will write the medical reports that are necessary to determine what workers’ compensation benefits you can receive. Accurately executing the medical reports is extremely important and significantly affects your workers’ compensation case.
What is the role of a Medical Provider Network?
A Medical Provider Network is a group of physicians authorized by your employer’s workers’ compensation insurance company to treat injured employees and often specialize in work-related injuries. If your employer’s workers’ compensation insurance has a Medical Provider Network, you must initially see one of their doctors. For the first 30 days following your on-the-job injury, your employer has the right to choose the physician for your initial evaluation. However, after those 30 days, you can choose a different doctor in the Medical Provider Network to treat you. If you pre-designated a doctor before your injury, then you are exempt from this requirement.
Can my personal physician treat my work-related injuries?
You can have your personal physician treat your work-related injuries, but you must have notified your employer before you were injured. You can predesignate a doctor who has treated you in the past, but you cannot predesignate your personal chiropractor or physical therapist. However, you may be able to switch to them after being seen by the doctor chosen by your employers’ workers’ compensation claims administrator if you give your employer the name of your chiropractor or physical therapist beforehand. To predesignate your personal physician, you must notify your employer in writing or use the optional DWC Form 9783. The following information is necessary to predesignate your personal physician:
- Your employer’s name
- A written statement that says if you become hurt on the job, you are designating your personal physician to provide medical treatment
- The name, address, and phone number of your physician or medical group
- Your name and signature
What type of medical treatment can I receive for work-related injuries?
Your primary treating physician must follow scientifically proven guidelines known as the medical treatment utilization schedule to treat your work-related injuries. The medical treatment utilization schedule consists of 14 sections and details house to treat each injury. It also includes a section on advising injured workers on ways to remain active while recovering from their injuries. The medical treatment utilization schedule also limits the amount of chiropractic, physical therapy, and occupational therapy appointments you can have. The Stockton workers’ compensation attorneys can help request additional visits from the claims administrator.
Sometimes medical conditions require treatments not outlined in the medical treatment utilization schedule. If your physician’s treatment requests not in the medical treatment utilization schedule, then the claims administrator may request a utilization review. If you have any questions about the medical treatment utilization schedule, your Stockton workers’ compensation attorney can guide you.
What is the purpose of a utilization review?
The workers’ compensation claims adjuster may request a utilization review to determine if your treatment is necessary. Your primary treating physician will submit a request for medical treatment authorization to your employer’s workers’ compensation claims adjuster. The workers’ compensation claims adjuster then sends that request for approval for utilization review by another doctor. The utilization review doctor evaluates the treatment based on the medical treatment utilization schedule. The utilization review doctor will make a decision to either approve, modify, or deny treatment. There are things you can do if you disagree with the determination made by the utilization review doctor to either modify or deny your treatment. A Stockton workers’ compensation attorney can help you through the steps that come next.
The workers’ compensation claims adjuster denied my treatment. Is there anything I can do?
If the treatment requested is denied following a utilization review, you and your Stockton workers’ compensation attorney may be able to request an Independent Medical Review. The purpose of an Independent Medical Review is to have an independent medical expert evaluate your injury and determine if there was a basis for denying treatment. An Independent Medical Review expert never physically examines you. They only review your medical records and any other documents pertaining to your injury to make their determination. If you received a denial of treatment from your employer’s workers’ compensation claims adjuster following a utilization review, you have 30 days to request an Independent Medical Review.
The medical treatment process of a workers’ compensation case can be extremely overwhelming. The Stockton workers’ compensation attorneys can direct you through the process and help you through a plan of action. We have represented thousands of clients through their workers’ compensation cases and have been practicing workers’ compensation law for over 25 years. We want to make sure our clients get the compensation they deserve so that they can focus on their recovery. If you have any questions, contact a Stockton workers’ compensation attorney for a free consultation today.