What Are the Workers' Compensation Medical Benefits in California?

California Workers' Compensation FAQ

What are the workers' compensation medical benefits?

Workers compensation medical benefits can help you in many ways.  If you are a covered employee and you have sustained a compensable injury, workers’ compensation insurance or your employer must pay the cost of your medical treatment.  You are entitled to all medical care that is reasonably necessary to cure or relieve your work-related injury or illness.  Covered expenses include a doctor, dentist, and hospital bills; medications (prescription and over the counter); medical tests; and medical equipment and devices (crutches, braces, artificial limbs).  In addition, you are entitled to mileage reimbursement for travel to medical appointments so be sure to keep a mileage log.

How does the insurance company determine what care is “reasonably necessary?”

The workers’ comp insurance company expects your doctor to follow established treatment guidelines.  The guidelines in current use are the Occupational Medicine Practice Guidelines, Second Edition, published by the American College of Occupational and Environmental Medicine (ACOEM).  These guidelines set out treatments that are proven effective to cure or relieve work-related injuries and illnesses.

What if my doctor recommends treatment not covered by the guidelines?

The insurance company will probably not authorize the treatment unless your doctor can show that it follows other scientifically based guidelines that are generally recognized by the national medical community.

How does the insurance company decide whether to authorize or deny treatment?

All workers’ compensation insurance companies are required to implement a utilization review process to determine if treatment is medically necessary.  Under this process, the claims administrator can approve treatment requested by your doctor, but cannot deny or modify it.  The decision to deny or change the treatment recommended by your doctor can be made only by another doctor knowledgeable about the type of illness or injury that you have and the recommended treatment.

If you are injured and the utilization review doctor refuses to authorize medical treatment you need, your Los Angeles workers’ compensation attorney can file a request for independent medical review in order to have another doctor review the UR doctor’s denial and decided if it was proper or if the treatment should be authorized.

Other than the medical treatment guidelines, are there any limits on the medical treatment workers’ comp will pay for?

Workers’ comp will pay for no more than 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits for your injury unless the claims administrator approves more visits in writing.

Pasadena Workers' Compensation Attorney

At Robert M. Harman & Associates, we care committed to protecting your rights and your future.  We have the knowledge and experience to help you obtain the most compensation possible.  We will work diligently and will keep you updated throughout the whole process.

Providing Workers' Compensation Services to the Greater Los Angeles Area since 2002