Van Nuys Medical Benefits Attorney

Worker’s Comp Medical Benefits in CA: What you need to know

You hope to work every day, put in your hours, do your job, and go home without incident. And most of the time, that is precisely what happens. Unfortunately, accidents do happen, and there could come a time when you get hurt on the job. Getting hurt on the job can mean time off work, resulting in lost wages and medical bills that stack up as you try to get back on your feet and back to work. Worker’s compensation in California provides medical benefits to be paid to people who have an injury or illness resulting from a job-related incident or accident.

Injured in the Workplace? You May Qualify for Medical Benefits

When a person gets hurt on the job, it could have a lasting impact on them, from chronic pain and compromised mobility to a severe financial strain. And while California law allows for certain earmarked payments for injured employees, it isn’t always easy to get all of the needed help. That is where a good worker’s comp attorney comes in. They can help secure current compensation for medical care and future care and eliminate out-of-pocket expenses and other responsibilities that belong on the shoulders of the employer. This can include diagnostic tests such as X-rays, MRIs, and blood work. It can also include treatment, hospital stays, emergency room visits, and even ambulance transport. If any special medical equipment is required, that is covered as well. If the person needs physical therapy or any ongoing treatment, the services are also included. However, for long-term health needs and other long-term care, compensation for future or ongoing treatment may not be all that easy to secure. You need an experienced, knowledgeable legal representation to ensure that those expenses are paid, so you don’t have to worry.

A Medical Benefits Attorney Can Help You get the Compensation You Deserve

If you have a worker’s compensation claim or are filing a claim, you need an attorney. There are many things to consider, and you don’t want to try to handle your case on your own. A worker’s comp attorney will investigate your injury and aid you in calculating the potential and probably expenses for future treatment. They will look at all aspects of treatment, including surgeries, consultations, treatments, medications, evaluations, and therapies. The very nature of most injuries is that they are very unpredictable. This makes litigation very complex. There are so many things to consider, like the probability of the condition getting worse over time, the impact on the person’s quality of life, and how health care will be adjusted to meet those needs. The legal team will also look at potential settlements and future payments. This may mean leaving the health care portion open or providing specific funds for future care. California law has specific guidelines for people who are hurt at work, and your attorney will help you remain compliant.

Reporting Work Injuries: Timelines and Deadlines

Missed deadlines are a common reason why medical benefits for a work injury claim are denied. Typically that happens because the person failed to report the injury within the prescribed timeframe. The reporting deadlines for injuries on the job can be confusing. There are a lot of provisions that California worker’s comp law makes regarding when an injury has to be reported. However, only two are of great concern to those filing a worker’s comp claim. The first is when an injury or illness should be reported to an employer. A good rule of thumb is to report it right away, even if you aren’t sure of the extent of your injuries. You will be evaluated by a health professional anyway, so you don’t need to go into great detail about how badly you are hurt at that time. California law gives all work injuries a 30-day timeframe. Even this can be confusing because there are specific requirements and stipulations. Plus, injuries and illnesses are rarely cut and dry, especially not work-related ones. Sometimes a person may not know that anything is amiss for a while. Because of this, the law allows for the 30-day reporting timeframe to begin when the diagnosis is made. The other deadline is for filing the claim for worker’s compensation. This is also a 30-day timeframe that begins the date the incident occurred.

Working With the MPN Designated Physicians

When a person is hurt or sick, they usually want to be treated by a doctor they trust and built a relationship with – their own doctor. Unfortunately, the California workers’ compensation system is not necessarily considered “injured worker-friendly.” The employer has a medical provider network (MPN) that operates with their insurance. Usually, treatment must be performed by one of those MPN designated physicians instead of with the employee’s regular or chosen doctor. These designated physicians are usually board-certified and are reasonably competent to handle the issue.

When a Claim is Disputed or Denied

There are many reasons why a claim may be denied. Failure to report within the prescribed timeframe is one of the top reasons. A professional may be able to help you with the following:
  • The injury is not work-related. This is a common claim that employers make. They try to say that the incident did not occur in the workplace. However, that claim can be debunked if the employee can provide evidence that shows otherwise, such as witness statements or video surveillance.
  • The injury is a pre-existing condition. If the employee has an illness or injury before their employment, then worker’s compensation will not cover it. On the other hand, if the pre-existing condition was aggravated or exacerbated by workplace elements, then the person typically receives coverage.
  • The injury occurred due to alcohol or drugs. If the worker was impaired by alcohol or drugs at the time of the incident, it could disqualify them.
  • The injured worker never sought medical treatment or evaluation. Anytime a person is injured on the job, they must see a doctor as soon as possible. If they do not seek treatment or at least an evaluation, they will not likely receive many benefits.
  • The injury was the result of negligent behavior. The worker’s comp system is technically no-fault, which means who caused the damage is irrelevant. But if the employee was grossly negligent, they could be disqualified.

What Happens in an Independent Review of a Disputed Claim

When a claim is disputed, it may go before a panel qualified medical evaluator (QME) for review. The worker usually has the opportunity to choose the QME from a list of providers. The Medical Unit assigns these QME physicians to examine and evaluate the worker and provide a report on their findings. This is called a utilization review (UR). When the employee’s eligibility is being determined, the UR is often used for both concluding whether or not they should receive the benefits and if the treatments that have been proposed are deemed medically necessary.

What can a Van Nuys Medical Benefits Attorney do for You?

You probably have some questions if you have a worker’s compensation claim and seek medical benefits. Our legal team will help you get the compensation you deserve and ensure that you receive all that you are owed, including medical care and settlement terms. If you have been hurt at work, don’t wait. Call a Van Nuys attorney today and get the help that you need. Best of all, we don’t get paid unless you do. In other words, when we secure your benefits for you, recover any damages, and negotiate a settlement, that is when we get paid. What could be easier? Don’t wait another minute. Call today.