Work-related injuries and illnesses remain a major problem. According to data collected and analyzed by the Bureau of Labor Statistics (BLS), there were 2.7 million injuries and illnesses reported at private-industry workplaces in the United States in 2020 alone. While some accidents were relatively minor, many required employees to miss significant time on the job to recover.
In California, no-fault workers’ comp benefits pay for medical care after a job-related injury. This raises an important question: What medical care is actually covered by workers’ comp? The short answer is that you can seek coverage for all “reasonable and necessary” medical treatment. In this article, our Fresno workers’ compensation lawyer provides a more detailed explanation.
Workers’ compensation insurance in California is designed to ensure that injured workers have access to the medical care that they need to make a fully physical and mental recovery after a job-related accident. Pursuant to the state’s workers’ comp regulations, an injured worker has the right to get coverage for all “reasonable and necessary” medical treatment. Depending on the nature and severity of your work-related injuries, you may be entitled to coverage for:
- Ambulance fees;
- Emergency room care;
- Doctors bills;
- Visits to specialists;
- X-rays and other imaging;
- Prescription medications;
- Psychological counseling; and
- Rehabilitative support.
Do you have health insurance coverage? If so, you are undoubtedly aware of the face that insurance coverage does not mean that all medical care is free. You can still get bills. For example, patients are often required to pay a deductible or a co-pay when getting treatment.
However, this is not how workers’ comp insurance operates. When medical treatment is deemed to be “reasonable and necessary” it is entirely covered by workers’ comp. There is no deductible or copay—meaning you should not receive a bill or be forced to pay out of your own pocket.
What to Do if There is a Dispute Over the Appropriate Medical Treatment
Workers’ comp claims are complicated. There can be disputes over what type of care is “reasonable and necessary” after a job-related accident in California. As explained by the California Department of Industrial Relations, insurers should pay for care that is “reasonably required to cure or relieve the effects of the injury” in accordance with “scientifically based medical treatment guidelines.”
If you are denied medical coverage by workers’ comp for care that you (and your doctor) believe is reasonable and necessary, you have the right to appeal. It is imperative that you take proactive steps to challenge the denial. Consult with an experienced Fresno, CA workers’ comp lawyer as soon as possible after receiving an adverse decision from the claims administrator/insurance company.
As a top-rated workers’ compensation lawyer, Joseph C. Yrulegui has the skills and legal expertise that you can rely on. If you have any specific questions or concerns about the type of medical benefits that are available through a work injury claim in California, we are here to help. Call us now or contact our Fresno office online to set up a confidential, no obligation initial consultation.