Medical Benefits

If you are injured in an on the job accident, or are diagnosed with a occupational illness, you may receive reasonable and necessary medical care, as prescribed by an authorized treating health care provider, for conditions related to the injury with no time limit.

Emergency care:

When an injury occurs, if immediate medical attention is needed, emergency care will be paid for, provided the claim is found to be compensable. Initial emergency care is not considered to be a selection of health care provider by either party.

Payment of care:

Authorized medical care is paid completely by the employer/insurer. Injured workers have no out of pocket costs. Health care providers should be directed to the adjuster to obtain prior approval of medical procedures, and all billing should be sent directly to the claims handler. Treatment received for a work-related injury should not be billed to a private health insurance company.

 Health care services are covered when:

The service is for a work-related injury or occupational illness;

The service is with an authorized health care provider;

The service provided is reasonable and necessary;

The service has been pre-approved by the claims handler.

 Health care services may not be covered if:

The service is with an unauthorized health care provider;

The service is for a condition outside of the work-related injury or occupational illness;

The service is determined not to be reasonable and necessary;

The claim for workers' compensation benefits is denied.

Physicians:

Throughout the course of your treatment you may be referred to many different doctors, with different areas of expertise. Below is a general listing of some of the types of physicians who treat workers' compensation and how and what they do.

 General practice or occupational physician: Usually a physician who is on the front line of treatment. Will likely treat your injuries in the beginning and prescribe the necessary medications, or when needed make referrals to specialists.

 Orthopaedic physician: Generally diagnoses and treats disease and injuries to the bones or joints. Some specialize in backs, necks, knees, hands, shoulders and surgery to these areas. Extensively trained in surgery to these areas.

 Neurosurgeon: Generally diagnoses and treats injuries to the brain, head, neck, back and neurological problems relating to these areas. Extensively trained in surgery in these areas.

 Neurologist: Generally diagnoses and treats injuries to nerves and diseases affecting nerves. This doctor, highly trained in testing procedures, does not perform surgery.

 Physiatrist: Soft tissue injury specialists. Generally treats injuries and problems which are not surgical in nature or people who have had surgery and need rehabilitation. This doctor does not perform surgery.

 Physical Medicine and Rehabilitation: Generally treats injuries and pain and related problems with medicine and rehabilitative techniques.

 Pain Management Specialist: Generally treats pain and related problems of a chronic nature with medicine and some invasive surgery.

 Psychiatrist: Generally diagnoses and treats mental injuries and problems associated therewith. May refer to psychologist for testing or counseling. A psychiatrist is a medical doctor and can prescribe medication.

 Psychologist: Generally diagnoses and treats mental and behavioral problems or depression or psychological or psychiatric problems from injuries. Highly trained in testing procedures and counseling.

 General Surgeon: Generally diagnoses and treats injuries which need surgery and are not in the orthopedist or neurosurgeon's expertise.

 Ophthalmologist: Generally treats and diagnoses problems and injuries to the visual senses.

 Chiropractor: Generally treats and diagnoses spinal and soft- tissue injuries of a non-surgical nature. Renders therapy to treat problems resulting from a lack of normal nerve functions. Employs manipulation and adjustments to body structure.

 Physical therapist: Generally provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities. Work under the direction of a referring physician.

Independent Medical Examination:

In some cases a worker may be required to be examined by a doctor other than the authorized treating physician, for the purpose of providing an independent evaluation of the worker’s medical condition and treatment plan. This is called an Independent Medical Examination (IME).

Both the claims representative and the worker have the right to request an IME. If the parties are unable to agree to an IME, either party may seek IME approval from a Workers' Compensation Judge.