At the Stockton Workers’ Compensation Attorneys, P.C., our attorneys are often asked the question. What type of medical treatment are you entitled to for a work-related injury? In the case of work-related injury or illness, you’re entitled to all medical care that is reasonably needed to cure or relieve you from the effects of an injury. So generally speaking, you are entitled to all medical care that is reasonably required to cure or relieve you from the effects of an injury or illness. However, what is considered “reasonably required to cure you of the effects of an injury or illness” is a major dispute in constant litigation that our attorneys deal with regularly.
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Factors Required for Work-Related Injury or Illness Medical Treatment
This issue boils down to two significant factors.
1. It has to be an evidence-based need.
2. The treatment must be recognized as a national standard, sometimes referred to as the Medical Treatment Utilization Schedule.
So, if the need for medical care is evidence-based and fits within that schedule, you’re entitled to it. To receive it, your treating doctor must fill out a request for authorization that has to walk through why it’s evidence-based and why it fits within the schedule. If they do that correctly, you should be entitled to that care. Within the scope of that, care can include everything from over-the-counter medicines to pharmaceutical medicines and surgery. It also includes physical therapy and chiropractic care up to certain limitations. Besides common medical care, people don’t often realize that if you sustained a severe injury that requires in-home nursing care. Then in-home care services can sometimes be an element of that medical care. Another essential aspect of reasonable care to be aware of is that the insurance company must pay transportation expenses relative to your care. However, these transportation expenses must be within reasonable standards.
Additional Medical Care Information
Another big issue that we deal with is the timing of the care and who provides the care. The first 30 days after an accident, unfortunately, the insurance company and your employer in 99 percent of the cases have the right to choose who your treating physician will be. However, that’s for the first 30 days. After the first 30 days, the employer loses that right to select who your treating physician will be. Instead, now you, the injured employee, have that right to choose who that care provider will be. Now it’s essential to understand that choice is not an unfettered right. You don’t get to go back to your primary physician who you visit for your personal health matters. But you do get to choose a primary treating physician or a treating physician out of the Medical Provider Network that the insurance company provides. The medical Provider Network is usually relatively large. Still, it’s highly recommended to consult with an attorney to help you choose a physician that can treat you in a way you like. And fill out the forms correctly to ensure your treatment is approved.
If you’ve got questions about medical care and treatment in your workers’ compensation matter, we strongly advise seeking professional advice from one of our expert workers compensation lawyers at the Stockton Workers’ Compensation Attorneys, P.C.. Our qualified team of workers’ compensation attorneys has over 100 years of combined experience handling workers’ compensation claim cases.
To speak with an attorney on our team and take advantage of your FREE no-obligation consultation, call us at (209) 323-5126.