I have been injured at work. Who pays for my medical care?
Your employer pays for medical care for your work-related injury or illness, either through a workers’ compensation insurance policy or by being self-insured. The claims administrator pays the medical bills. You need to take action, if you get any bills.
Medical BillsYou should never receive a medical bill, as long as you filed a claim form and your physician knows that the injury is work-related. Although you SHOULD not receive a bill, some medical providers erroneously send you a bill. DO NOT disregard the bill. Respond to the medical provider and advise that:
THIS IS A WORKERS' COMPENSATION CLAIM. PLEASE BILL THE INSURANCE COMPANY. It is illegal for a physician or medical facility to bill a worker if they know the injury is or may be work related."
This law is found in California Labor Code section 3751(b).
What kind of medical care is available to injured workers?California workers* compensation law requires claims administrators to authorize and pay for medical
care that is *reasonably required to cure or relieve* the effects of the injury. This means care that follows scientifically based medical treatment guidelines.
Unfortunately, it is a lot more complicated than that. As an injured worker, you need to be aware of UTILIZATION REVIEW and IMR. Getting medical care in California workers' compensation claims is not easy. Always consult with an experienced work injury attorney.
Los Angeles Super Lawyer: Nikki Mehrpoo Jacobson, Certified Workers' Compensation SpecialistNIKKI MEHRPOO JACOBSON
Attorney at Law
Certified Workers' Compensation Specialist
By The State Bar of California Board of Legal Specialization
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Medical treatment guidelines used in CaliforniaThe medical treatment guidelines currently being used in California are in the medical treatment utilization schedule (MTUS) published by the Division of Workers* Compensation (DWC). The current MTUS includes portions of the Occupational Medicine Practice Guidelines, Second Edition, published by the American College of Occupational and Environmental Medicine (ACOEM), as well as other guidelines. They also include guidelines for acupuncture treatment, chronic pain treatment, and post-surgical treatment. The MTUS is currently being updated.
The medical treatment guidelines are designed to help physicians give appropriate treatment. This
includes advising and guiding the injured worker on how to remain active while recovering, and informing the employer about the kinds of changes at work that are needed to promote recovery. Such changes could involve different job assignments, reduced working hours, or other accommodations that are safe and appropriate for the particular injury.
If your doctor recommends treatment that is not in the guidelinesSome injured workers have medical conditions requiring treatment that is not in the MTUS. If your
doctor recommends treatment not in those guidelines, the claims administrator is required to pay for the treatment if it follows other scientifically based guidelines that are generally recognized by the national medical community. (Some treatment guidelines, for example, are available online at the website of the National Guideline Clearinghouse: www.guideline.gov.)
If your case is settled with an agreement on future medical careIf you and the claims administrator settled your workers* compensation case with an agreement that you
will continue to receive medical care for your injury, the medical treatment guidelines and rules described
above still apply to you. The guidelines and rules apply to all treatment, even in cases that settled before
medical treatment guidelines were added to workers* compensation law.
You should always consult with an experienced work comp attorney about your case.