If you have recently suffered an injury at work, one of your first concerns about moving forward may be how to pay your medical bills. Fortunately, if your injury is found to be work-related, then your employer will be responsible for paying your medical bills that are reasonable and related to your work injury. Your employer will pay these bills either through their workers’ compensation policy or by being self-insured.
Workers’ Compensation in California
If you have concerns about getting your medical bills paid in your work injury case, a California workers’ compensation attorney can help. The attorneys at Kneisler and Schondel have many years of experience helping injured workers get the benefits they deserve. Contact our office today to schedule a consultation to meet with one of our attorneys and get started with your workers’ compensation case.
Initiating Medical Treatment
If your injury incident is an emergency, your employer is required to ensure that you have immediate access to emergency treatment. For other injuries that are not immediately urgent, the claims administrator handling your workers’ compensation claim must authorize medical care within one work day after you file your claim form. While the claims administrator has the right to investigate your claim, they must also authorize necessary treatment in the meantime up to $10,000.
Which Doctors Can Treat Me for My Injuries?
If you have predesignated your physician or medical group before your injury, you can be treated by this doctor or physician group. In this case, you can go to your predesignated physician to receive treatment right away after your injury has occurred.
In some cases, your employer or the insurer will have a medical provider network or a healthcare organization contract set up to treat their injured workers. Medical provider networks must be approved by the Division of Workers’ Compensation. If your employer has a medical provider network, it is required to provide you with written information regarding the network. If your case involves this type of arrangement, your initial treatment will typically be within the network unless you have predesignated your physician.
Less commonly, you may receive your initial treatment through a health care organization. A health care organization for this purpose is certified by the Division of Workers’ Compensation and is contracted with an insurer or employer to provide injured workers with managed medical care. If your employer or their insurer has an HCO contract, you should have been notified and given the option to enroll.
Getting Your Medical Bills from Your Work Injury Paid
It is crucial to know your legal rights when it comes to work injuries. Under California law, it is illegal for a medical facility or physician to bill a worker for treatment if they know that the injury is work-related.
Your employer or claims administrator must authorize and pay for any medical treatment that is reasonably required in order to cure or relieve the effects of your injury. This means that the medical care you receive must follow scientifically0based medical treatment guidelines.
In California, the medical treatment guidelines currently in use are in the medical treatment utilization schedule that the Division of Workers’ Compensation publishes. These guidelines are issued to help doctors recommend appropriate treatment plans. Generally, if your medical care remains within these guidelines, the claims administrator will authorize and pay for your treatment.
However, in some cases, your doctor may recommend treatment that is not within the guidelines. If this happens to you, the claims administrator on your case must still pay for the treatment if it follows other guidelines based on science that are generally recognized by the national medical community.
What Happens If the Claims Administrator Denies My Medical Treatment?
If the claims administrator refuses to authorize or pay for medical treatment recommended by your doctor, the first step is to find out why. The reason for the denial could be something simple to fix, such as sending in additional documentation that supports the need for the treatment.
If your recommended treatment continues to be denied, you have the right to request an independent medical review. You must make this request within 30 days after you receive the denial decision from the claims administrator. An independent medical review of the requested treatment will be performed by an independent medical review organization called Maximus.
If the review comes back in your favor, then the treatment should be authorized, and you can move forward with the treatment plan. If not, your workers’ compensation attorney can advise you of the next steps available in your case.