When a work-related injury or illness occurs the first question is, “Who pays for my medical care?”
The short answer is: your employer. Whether they are self-insured or have a workers compensation insurance policy, your employer is responsible for any medical bills associated with your treatment. Each employer has a designated claims administrator that handles all the bills.
Seek Medical Attention Immediately
It is important to obtain medical treatment as soon as possible after a job-related illness or injury occurs. Not only does it give you better opportunity for a positive outcome, but it also allows your physician to document your situation from the onset. It is critical that you inform the medical team that this is a work-related occurrence. In the state of California it is illegal for a physician or a medical facility to bill a worker if they know the injury may be job related, BUT you must inform the treating doctor that your illness or injury is work-related.
You MUST File a Claim
After you have received appropriate medical attention you must file a claim with your employer. This is also the time to engage the assistance of an experienced workers compensation attorney, particularly if your employer attempts to discourage you from filing a claim. Workers compensation insurance is expensive for businesses, and many well-meaning employers will offer to pay your medical expenses outright if you agree not to file a claim. This may be a tempting offer, especially if you have a long-standing or good relationship with your employer. DO NOT ACCEPT THIS OFFER. The only way to safeguard your rights for the future is to file a claim.
What Kind of Medical Care Will I Receive?
The California Labor Code directs that care must follow “scientifically based medical treatment guidelines”. These guidelines are designed to help physicians provide appropriate treatment, including parameters for chronic pain treatment, post-surgical treatment, and therapies such as acupuncture. It is possible that your illness or injury may require treatment not contained within the guidelines. In that case, the claims administrator is required to pay for treatment if it follows other scientifically based guidelines that are generally accepted by the medical community. If your doctor recommends a treatment that the claims administrator doesn’t want to pay for, my team will step in and advocate on your behalf to resolve the situation in your favor.
In addition to providing guidelines for care, the California Labor Code also requires medical professionals to advise the employer about the kinds of changes at work that are necessary to foster recovery. This could include different job assignments, reduction of working hours, or providing specific equipment. Sometimes employers don’t understand the importance of making these accommodations, and that’s when having an attorney advocate for you becomes important.
Protect Your Rights
Laws protecting workers evolved because employers didn’t always provide compensation for accidents, injuries, or illnesses resulting from the operation of their business. Do not assume that because you feel fine now your injury or illness won’t cause complications in the future. As the saying goes, it’s better to be safe than sorry. If you file a claim now, documenting the situation thoroughly, you will establish the baseline by which future care will be awarded. Let us help you protect your rights both now and for the future. Call our office or schedule a consultation request today.
