Padilla Law Group, LLP

How medical care is addressed through workers' compensation

Californians who are injured on the job may be happy to hear that they may qualify for workers' compensation benefits. However, there is often confusion about what, exactly, these benefits can cover. This week we hope to shed some light on how medical care is addressed through the workers' compensation system.

Generally speaking, workers' compensation benefits are paid out to cover the costs for medical care that are "reasonably" required to either cure the medical condition at hand or relieve the effects of any workplace injuries or illnesses suffered. The workers' compensation system has taken this to mean that treatment must be based on certain medical guidelines, which are developed and published by the Division of Workers' Compensation. Of course, the Division develops these guidelines in conjunction with medical organizations.

These guidelines allow doctors to provide and workers to receive many kinds of medical treatment. Surgeries, rehabilitation and even chiropractic services may be available to an injured worker. The key is that the treatment must fall within the guidelines and must be reasonably necessary to treat the condition in question. However, even doctor-recommended treatment that falls outside of the guidelines could be covered if it is in line with guidelines recognized by the medical community nationwide. Some of these services, though, have restrictions. For example, chiropractic visits are limited to 24 visits unless otherwise authorized.

Even though there are restrictions on the type and the extent of medical care that can be paid for through workers' compensation, it still goes a long way towards helping a worker reclaim his or her life and, hopefully, get back to work. The process can be complex, though, and many claims are denied. Therefore, it is important to seek the guidance needed to ensure that your claim is as legally sound as possible before moving forward, or to build a strong appeal, if necessary.



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