An injured worker may have the right to receive both income and medical benefits regardless of who was at fault for the injury. Income benefits are initiated on the 8th day of missed time from work and medical benefits are paid according to what is considered reasonable and necessary for the accepted injury. An injured worker may not be entitled to benefits when the injury occurs due to the following:
2. Attempt to injure self or while trying to injure someone else
3. Another person intentionally injuring the employee due to personal reasons
4. Act of God
6. While voluntarily participating in an off-duty recreational,social, or athletic activity.
Most of these denials can be successfully challenged by a skilled attorney.
You Have a Right to Choose A Treating Doctor
Often times the injured worker is referred to a doctor by the employer. If the injured worker is not satisfied with the initial doctor, the injured worker has a right to change doctors within the allotted time. In submitting for a change of doctor the following rules must be followed:
1. If you are in a Workers' Compensation Health Care Network you must choose a doctor from the network's treating doctor list.
2. If you are not in a network you may choose any doctor that is willing to treat your workers' compensation injury.
3. The procedural rules to change treating doctors must be followed. If the proper procedure is not followed the insurance carrier may deny payment of medical bills.
You Have a Right to Receive Medical Treatment
An injured worker has the right to receive medical care to treat your workplace injury and/or illness, so long as it is considered medically necessary and related to the workplace injury. The injured worker may challenge the insurance carrier's determination that the medical treatment is not medically necessary and related to the workplace injury by requesting a Benefit Review Conference. In order to succeed in an extent of injury dispute it is advisable the injured worker seek legal representation or receive ombudsman assistance.
You Have a Right to Receive Ombudsman Assistance
An ombudsman is an employee of the Office of Injured Employee Counsel. An ombudsmen are trained and may provide free assistance to injured employees who are not represented by attorneys. However, an Ombudsman is not an attorney and cannot provide legal advice or the confidentiality protections afforded by an attorney-client relationship.
You Have the Right to Hire an Attorney at Any Time to Help You with Your Claim
Whether you recently sustained an on-the-job injury or have been navigating the system for a while-You have a right to hire an attorney.
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