The Importance of Medical Treatment in California Workers’ Compensation Cases

The purpose of this blog is to provide a general overview of medical treatment for employees injured on the job in California. 

When a worker gets injured while on the job in California they often face a situation both physically and emotionally. During these times it is crucial to understand the role that medical treatment plays in workers compensation cases in California. This article is for legal information purposes only and is not intended nor is legal advice. In this blog post we will explore the significance of treatment, the process involved, and what injured workers should be aware of to ensure they receive the care they need.

The Foundation of Workers Compensation

The California Workers’ Compensation is a system created to safeguard employees who suffer injuries or illnesses due to their work. One of its aspects is providing treatment for injured workers. 

The ultimate aim is to guarantee that employees receive appropriate attention that aids their recovery and facilitates their return to work whenever feasible.

Reporting the Injury

The process typically commences when an employee sustains an injury while on duty. It is crucial to inform your employer about the injury. However, sometimes, it isn’t necessary for your to report your injury, like when you suffer an injury in the presence of your supervisor or manager.  

Generally, the best practice is to report your injury, in order to initiate the workers compensation process, which includes receiving treatment. Employers are then obligated to provide injured employees with medical care.

The Role of the Treating Doctor

When it comes to workers compensation cases, in California the choice of a treating physician has an impact on the outcome for an injured worker. Typically the employer’s insurance company has the authority to select the treating doctor who must treat the employee for 30 days. You can ask your attorney to switch to another doctor once the 30 days is over and you are unhappy with your medical care. 

The treating doctor plays a critical role in assessing and understanding the extent of the injury, providing treatment recommendations, and determining when an injured employee can resume work. Their reports and medical opinions hold influence over how the workers compensation claim progresses.

The Importance of Medical Evidence

A workers’ compensation case must be developed through medical evidence. Medical evidence forms the foundation of all properly litigated workers’ compensation cases. This evidence comprises records, reports, and evaluations conducted by the treating physician. It serves three main purposes;

1. Assess The Nature and Severity of The Injury

The assessment made by the treating doctor is vital in determining both the severity and nature of an employee’s injuries. Such information plays a role in calculating compensation benefits since severe injuries often result in higher benefits.

2. Establishes The Necessity for Medical Treatment

Medical evidence provides justification for treatments recommended by the treating physician, by establishing their relevance to workplace injuries and their necessity, and for aiding in an injured worker’s recovery.

3. Determination of Temporary/Permanent Disability Benefits

If an employee gets injured and is unable to work due to the injury they may be eligible for disability benefits. These benefits are provided based on evidence that determines the duration for which they should be paid. In some cases, the disability is permanent and long-term payment of benefits might be necessary.

Guidelines for Medical Treatment

California has implemented guidelines for treatment that outline the care for different types of workplace injuries. The purpose of these guidelines is to ensure that injured workers receive care based on medical evidence and best practices. Understanding these guidelines can be advantageous both for injured employees and their treating physicians.

The Role of Utilization Review

In some cases the workers’ compensation insurance company may conduct a utilization review to assess whether the recommended medical treatment aligns with the established guidelines. The insurance companies generally claim that this process aims to control costs and prevent unnecessary treatments.

It’s crucial for injured workers to have an attorney who is familiar with the utilization review process and the injured worker’s rights within it. They have the right to challenge decisions that deny or modify recommended treatment.

Disputes and Medical Treatment

Disagreements concerning treatment can arise during the workers’ compensation process. Injured workers might find themselves in disagreement with their treating physician, the insurance company, or decisions made through utilization review.

Injured workers have the right to retain legal representation in order to resolve disputes and ensure they receive necessary medical care. Legal professionals who specialize in workers’ compensation law, like Gateway Pacific Law Group, have the expertise to advocate for the rights of injured employees to receive the medical treatment they need.

Qualified Medical Examination (“QME”)

A QME is essentially an independent medical evaluation that is conducted by a doctor who is certified by the State of California. This doctor is not associated with the employer or their insurance company, which is important for ensuring fairness in the evaluation process. The doctor will review the medical evidence, examine the injured worker, and review the injured worker’s deposition transcript (if one has been taken).

The purpose of a QME is to provide an unbiased assessment of an injured worker’s injuries and medical condition related to the workplace injury the worker experienced. Once the QME examination is completed, the doctor will prepare a report that includes their findings and opinions. This report holds significant weight in an injured worker’s case. It can impact decisions regarding the benefits the employee receives, the type of medical treatment recommended, and whether the injured worker is eligible for disability compensation, among other things.

Getting Back to Work

When it comes to treatment in workers’ compensation cases, the ultimate aim is to aid the employee’s recovery and facilitate their return to work. The treating doctor plays a role in determining when an injured worker is medically cleared to resume their job responsibilities.

Employers are also encouraged to participate in the process of helping employees return to work by offering alternative work arrangements when necessary. This can assist injured workers in transitioning into the workplace. Employers that fail to evaluate a request for accommodation, may violate California’s Fair Employment and Housing Act.

Protecting Your Rights

As a worker in California it is important that you take an active role in your treatment and stay well informed about your rights regarding medical treatment in workers compensation cases. Here are some key steps you can take to safeguard your rights;

1. Promptly Report Your Injury

Notify your employer about your workplace injury soon as possible. Delaying this step may complicate your workers compensation claim.

2. Maintain Communication with Your Treating Physician

Ensure that you maintain clear communication with your treating physician. Make sure they have an understanding of the specifics of your injury and the requirements of your job.

3. Consider getting representation

If you come across any disputes, denials or obstacles regarding your treatment consult with a workers’ compensation lawyer, like Gateway Pacific Law Group. A lawyer that practices workers’ compensation law can offer advice and stand up for your rights.

Conclusion

Medical treatment plays a role in California workers compensation cases. It aims to help injured employees heal from their work-related injuries. It also ensures the injured worker receives the necessary medical care and support, to get back to work and resume their lives. 

By understanding how medical treatment functions within the system and being aware of their rights, injured workers are in a better position to advocate for their well being. However, it is always recommended that if an injured worker is uncertain about the workers’ compensation process, they should obtain the services of a lawyer in order to ensure the injured worker obtains the care and benefits they rightfully deserve.

Workers Compensation lawyer Roger Haag
About The Author

Roger Haag is an attorney who specializes in consumer, labor, and employment law, primarily representing employees. Mr. Haag has extensive experience in various legal proceedings, including arbitration hearings, administrative hearings, bench and jury trials, and has even presented arguments before the California Courts of Appeal. Additionally, Mr. Haag served in the United States Navy and also has professional experience with the Department of the Navy’s Civilian Acquisition Workforce and Chief of Naval Operations Executive Panel in Washington D.C.

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