Medical Treatment After a Workplace Injury in Orange County

Through workers’ compensation, you should be entitled to compensation and/or reimbursement for the costs of all “reasonable and necessary” medical care to get you back to your pre-injury condition—or as close to it as possible—following a workplace accident. It is important to understand that there are numerous rules and procedures you must abide by if you want to ensure that your medical expenses will be covered by workers’ comp.

Unfortunately, seeking medical treatment after a workplace injury in Orange County can be a confusing process even if you have dealt with workers’ comp before, which is why seeking professional legal assistance can be so important to achieving a positive claim result. A knowledgeable workers’ compensation attorney could explain every regulation that applies to your particular situation and work diligently on your behalf to make sure you get the compensation you deserve for the treatment you need.

Seeking Medical Care from the Right Physicians

In Orange County and throughout California, the phrase “reasonable and necessary” has a specific legal definition in the context of medical treatment following a workplace injury. Specifically, employers and claims administrators must follow the guidelines set out in the state Division of Workers’ Compensation’s medical treatment utilization schedule and maintain a utilization review program to determine whether a particular form of treatment should be approved as compensable through workers’ comp.  In addition, California has a complicated system of approving medical care through Utilization Review and Independent Medical Review.   When care is denied through utilization review there are strict time frames to approve the denials

Workers who predesignate a specific physical or medical group prior to a workplace injury as the party or parties they will seek medical care from if they are hurt on the job can go to those designated physician(s) for treatment following a workplace accident. Otherwise, an injured employee generally must seek treatment from someone within the medical provider network provided by their employer and approved by the DWC, although they are not necessarily required to stick with the same doctor within that MPN for the duration of treatment.

In situations where an injured worker has not predesignated their own preferred physician and their employer has not established an MPN, the claims administrator for that injured worker’s employer has the exclusive right to designate where that worker will seek treatment for the first 30 days after their injury. Once those 30 days pass, the employee can generally seek treatment from any physician and/or facility they choose, so long as they are within relatively close geographic proximity to their employer.

Contesting a Physician’s Opinion About a Workplace Injury

Regardless of where an injured worker receives treatment or who they receive it from, it is not uncommon for either that employee or their employer’s claims administrator to disagree with a physician’s opinion about the severity of an injury and/or a specific treatment plan. In this scenario, whichever party wants to contest that opinion may do so by requesting a qualified medical evaluator—generally another physician who meets specific licensing and educational requirements—to review their case called a Qualified Medical Evaluator.

Anyone who disagrees with an evaluator’s ruling regarding medical treatment for a workplace injury in Orange County has up to 30 days to appeal the decision to the Workers’ Compensation Appeals Board. A seasoned lawyer could discuss this and other options for resolving disputes over medical treatment during a confidential consultation.

Learn More About Medical Treatment After a Workplace Injury from an Orange County Attorney

Getting medical benefits through workers’ compensation can be crucial to protecting your long-term financial security and physical health. However, they can also be deceptively challenging to obtain depending on what kind of treatment you need and whether you agree with the various other parties involved in your claim about where you will go for care.

A qualified lawyer could provide irreplaceable assistance with getting the medical treatment you need after a workplace injury in Orange County. Learn more by calling today.