A Santa Rosa workers compensation lawyer explains why it is best to notify employers of every work-related injury
Some work-related injuries are too minor to trigger entitlement to workers compensation benefits. However, even minor injuries can lead to more serious problems. Employees will protect their right to receive benefits by reporting every injury to an employer.
The Employer’s Duty to Provide Medical Treatment
California’s workers’ compensation system requires an employer to provide medical treatment for a work-related injury when treatment is “reasonably required to cure or relieve the effects of his or her injury.” Whether medical treatment is “reasonably required” is determined by guidelines known as the medical treatment utilization schedule (MTUS). Those guidelines have been adopted by the Division of Workers’ Compensation to clarify the kinds of treatment that employers must provide for work-related injuries.
An employer must arrange an initial medical evaluation and begin treatment as soon as an employee notifies the employer of the injury and files a workers’ compensation claim. Immediately reporting a work injury to the employer removes all doubt about the employer’s duty to provide medical treatment.
If an injured worker reports an injury and requests treatment that the employer refuses to provide, the injured worker may seek treatment for the injury at his or her own expense. The injured worker can then file a workers’ compensation claim to obtain reimbursement of the cost of the treatment received. If a workers’ compensation judge (or the employers’ workers’ compensation insurance company) agrees that treatment for the injury was reasonably required, the employer may be required to reimburse the injured worker for the cost of that treatment. The employer may also be required to pay a penalty to the injured worker for its failure to provide medical treatment.
An injured worker will not obtain reimbursement of medical expenses, unless he first notifies the employer of the injury and the employer refuses to provide the necessary medical treatment. Notifying the employer of the injury therefore protects an injured worker’s right to be treated for the injury at the employer’s expense.
Injuries that Can Be Treated by First Aid
Reporting a work-related injury triggers the employer’s obligation to provide a workers’ compensation claim form. However, no disability benefits will be due to the injured worker unless:
- the injured worker loses three or more days from work, and
- the injury requires medical treatment beyond first aid.
“First aid” is defined as “any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care.” Whether an injury requires first aid or more significant treatment is occasionally a disputed issue. For instance, an employer may view an injury as “not serious enough” to justify a workers’ compensation claim. An employee who thinks an injury requires medical care may want to file a claim form with the employer anyway to protect the right to receive medical treatment. In most cases, filing the claim form takes the treatment decision out of the employer’s hands and triggers a careful evaluation of the claim by a workers’ compensation insurance company’s claims administrator.
Filing the claim form may require the claims administrator to authorize up to $10,000 worth of medical treatment. The injured worker can then obtain a medical evaluation and have a doctor determine whether the injury needs further treatment and whether the injured worker should stop working while the injury heals. An employee who files a claim form generally cannot be billed for medical treatment until after the claims administrator denies the claim and notice of the denial is provided to the treating physician.
Reasons to Report Minor Injuries
Employees may not always know whether an injury is “minor.” For example, it might be possible to treat a minor puncture wound with first aid. The wound might become infected, however, and the infection might cause the employee to miss work. At that point, the employee will be entitled to workers’ compensation benefits, including medical treatment and (if the employee misses more than three days of work) temporary disability benefits.
Reporting the minor puncture wound to the employer when it happens makes a record of the fact that the puncture wound occurred at work. The employer cannot deny knowledge of the injury or deny that it was work-related if the employer is notified of the injury when it occurs. That makes it less likely that benefits will be denied if the puncture becomes infected.
Of course, the employer should also be notified of the infection as soon as it occurs. Since the infection would likely require additional medical treatment, even if the puncture wound did not, the employer would be required to provide the employee a claim form after being notified of the infection. If the employer does not do so, the employee should file a claim form anyway. Injured workers’ can obtain claim forms from a workers’ compensation lawyer.
Some employers discourage employees from taking time off work following a work injury. For example, an employee may experience back pain while lifting something heavy, and the employer might advise the employee to “tough it out” or to “work through it.” The injured employee, however, may not be in a position to determine whether the injury is just a minor one. In some cases, continuing to work could aggravate the injury and make it more serious.
Neither the employee nor the employer are qualified to decide whether a “hidden” injury is serious or minor. Back pain for instance, could be the result of torn muscles, damaged cartilage, or other serious injuries that can only be diagnosed by a doctor. Whenever the severity of an injury is unclear, the employee should report the injury and ask to see a physician. If the employer refuses to provide the medical care, the employee should file a claim form and seek legal advice.
Getting Help with Workers Compensation
When employers refuse to cooperate with an injured worker’s request for medical treatment, or when there is a disagreement about the severity of an injury, the injured worker may benefit from legal advice. To discuss your work injury with an experienced Santa Rosa workers’ compensation attorney, call Kneisler & Schondel at (707) 542-5132. You can also tell us about your problem by submitting our online contact form.