Medical Treatment Disputes in Workers’ Compensation Claims

California Workers’ Compensation Laws provide certain benefits to employees injured on the job, including medical treatment for the industrial injury. At the initial evaluation, the workers’ compensation doctor will create a treatment plan which may include consultations with specialists, conservative medical treatment, diagnostic testing, and/or surgery. This means that the injured worker will be entitled to receive all the medical treatment included in the treatment plan, right? Not necessarily.

A medical treatment dispute occurs in a workers’ compensation claim when a request for medical treatment by a workers’ compensation doctor is denied, modified, or delayed by the workers’ compensation insurance company. At this juncture, the injured worker will begin to receive notices about the denied, modified, or delayed decision. This can be confusing because the injured worker’s expectation of prompt medical treatment is diminished by the same process that is intended to expedite the injured worker’s right to medical treatment.

Often times, an employee will come to my office in order to make sense of these notices. He/she will ask, “Is my claim denied? Is my claim is trouble? Why was the doctor’s treatment recommendations denied/modified and is this legal?” I explain that the workers’ compensation insurance company has decided not to approve the requested medical treatment and the importance of participating in a process called Independent Medical Review. It is important to note that the injured worker has the burden to appeal the decision and if the injured worker fails to timely do so, the decision from the workers’ compensation insurance company will be final and will stand for one (1) year.

If you are in this situation, you may not want to go through this process alone. An injured worker’s right to medical treatment is one of the most important benefits under workers’ compensation laws and should not be overlooked.

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