Under current California workers’ compensation law, any worker who sustains an injury or illness on the job and has access to workers’ compensation coverage through their employer, is entitled to various medical benefits and temporary healthcare. Importantly, workers’ compensation specifically only covers “reasonable medical treatment” but what counts as reasonable in the context of necessary medical care could be a deceptively complex and subjective matter.
No matter what type of trauma you sustained, it is always important to seek immediate medical treatment after a workplace injury in Tulare County and make sure your condition is fully stabilized. Then you should strongly consider retaining a knowledgeable workers’ compensation attorney who can help you file a workers’ compensation claim that accounts for all your current and future medical needs.
California law sets out guidelines and rules for what constitutes reasonable and necessary medical treatment in the Medical Treatment Utilization Schedule (MTUS), which is built around “evidence-based medicine” as well as previously established guidelines from the American College of Occupational and Environmental Medicine. With extremely few exceptions, only treatments that meet MTUS regulations as interpreted by a particular employer’s review program could be considered “reasonable” within the context of a workers’ compensation claim.
If an injured worker’s employer has a designated medical provider network (MPN) or health care organization (HCO), that worker will generally have to seek medical treatment after a work-related accident in Tulare County from a doctor within this pre-established network, unless they have already predesignated their own personal physician or medical group. If no such guidelines have been established, the claims adjustor for the worker’s insured employer can choose who the worker must seek treatment from for the first 30 days after the employer was notified of their injury, after which point, the employee may seek treatment from any reasonably geographically close physician they choose.
Reasonable medical treatment for a workplace injury in Tulare County could include not only emergency care, but also follow-up appointments, prescription medications, physical therapy, and even assistive equipment, like crutches or wheelchairs, as recommended by physicians. Injured workers are usually also eligible for reimbursement of travel expenses if they need to drive or take public transit to doctors’ appointments.
It is worth noting that workers’ compensation is not meant to last indefinitely, and once an injured worker’s condition seems to be stabilizing, the insurance company providing coverage will generally seek to close the claim with a final settlement that the worker cannot go back and change if their injury gets worse later or does not heal properly. A skilled attorney can estimate what future care an injured worker will need and ensure that a workers’ compensation settlement covers all associated expenses.
While workers’ compensation should cover all the medical care you need to recover from a work-related accident, that does not mean you can go to any doctor and bill your employer. There are specific rules and procedures you need to follow when seeking medical treatment after a workplace injury in Tulare County. Not following them can lead you to face a pile of medical bills on your own.
Guidance from a seasoned lawyer can be key to complying with state law and making sure you get the most benefits possible from your workers’ compensation claim. Contact our firm today so we can help you.
