Are you an employee in Fresno County? If so, you are entitled to workers’ comp that will provide benefits in the event that you are injured or made ill on the job. Under California Labor Code § 3700, it is mandatory for businesses and organizations to provide workers’ comp insurance to employees.
Among other things, workers’ comp insurance will provide you with coverage for all reasonable and necessary medical care.In this article, our Fresno workers’ compensation attorney answers some of the most commonly asked questions about medical care and workers’ comp in California.
In California, workers’ compensation insurance provides broad medical coverage. Under state law, a workers’ comp insurer is required to authorize payment for any medical care that is “reasonably required to cure or relieve” the adverse impact of the injury/illness. In other words, you are entitled to coverage for all of the medical treatment—including rehabilitative care—that you need to make a complete recovery.
It depends on the circumstances. In an emergency, an employer/insurer/claims administrator has a duty to ensure that the injured worker gets access to the immediate treatment that they need. Emergency medical needs always come first. Other considerations are secondary. For non-emergency situations, medical treatment should be authorized within one day of the official recipient of a workers’ comp claims form. The general rule is that up to $10,000 in medical care should be authorized while a workers’ comp claim is still being investigated.
How Do You Determine What Medical Care is “Reasonably Required”?
Every injured workers’ medical situation is unique. Following a workplace accident or the development of an occupational disease, you need care that actually addresses your underlying medical needs. In some cases, there are disputes regarding whether or not medical treatment is “reasonably required.” California regulators have created a medical treatment utilization schedule (MTUS) to help resolve conflicts.
In California, injured workers have the right to appeal the denial of a workers’ compensation claim. Neither your employer nor an insurer gets to make the final determination of your claim. You can file an appeal to challenge the denial of benefits—whether because your entire workers’ comp claim is being denied or because certain medical coverage is being denied on the grounds that the treatment in question is not “reasonably required.” A Fresno, CA workers’ comp lawyer will help you pursue the full and fair benefits that you deserve.
Joseph C. Yrulegui is a top-rated workers’ compensation lawyer. If you have any questions about medical care, medical benefits, and your rights after a job-related accident, we can help. Contact us now for a fully confidential, no obligation initial consultation. Our attorney represents injured workers all over the region, including in Fresno, Clovis, Sanger, Selma, Reedley, and Madera Acres.