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What is the Process for Receiving Treatment or Benefits Under the Workers’ Compensation system?

First, What is Workers’ Compensation?

Under California state law, employers are liable for bearing the cost of any occupational illness or injury. This allows employees to receive medical treatment and wage replacement benefits for work-related injuries. This includes doctor’s visits, hospital visits, diagnostic testing, surgery, medical supplies, temporary disability payments, and if an injury is deemed permanent, permanent disability benefits and vocational rehabilitation benefits.

If you are injured at work, you should immediately notify your employer or supervisor. The importance of this cannot be overemphasized. If your injury has not been documented at work, treatment may not be covered by Workers’ Compensation.

You can seek evaluation by a physician or other appropriate medical provider once your employer notifies their insurance carrier, treatment is authorized and a claim number has been issued. Of course, if it is a life-threatening emergency, call 911 or proceed directly to the nearest emergency medical facility.

Once you have had a preliminary medical examination, your provider will request authorizations from your Workers’ Compensation insurer for medically necessary diagnostic testing, specialty consultations, physical therapy and other treatments or testing.

Your medical provider is required to give an opinion as to whether they believe the injury is work-related. They are also required to determine your work status and will let your employer know whether you can perform your full duties at work, require limited or modified work duties, or are unable to return to work.

 

 Who can treat me for a work injury?

Any medical doctor, doctor of osteopathic medicine, chiropractor, podiatrist, dentist, or psychologist, provided the injury is within the scope of their practice as defined by California state law. Physician’s assistants and nurse practitioners may also provide medical care under the supervision of a physician.

The worker’s compensation system only allows one “Primary Treating Physician.” The primary treating physician coordinates all of your care and may refer you out to specialists for consultation and/or treatment.

 

Do all doctors take Workers’ Compensation cases?

Unfortunately no! Workers’ Compensation laws and insurance have complex regulations and reporting requirements that are difficult for medical providers to comply with unless they are dealing with them on a regular basis.

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