Medical Care Cost

What are Some of The Medical Treatment Costs Covered in Workers’ Compensation?

Medical Treatment benefits in workers’ compensation, is provided by employers, or insurance companies on behalf of the employer, to injured workers. Some of the most common benefits provided to injured workers through the workers’ compensation system are medical treatment, which is reasonably necessary to cure or relieve the effects of the industrial injury, disability benefits, and a supplemental job displacement benefit to help injured workers with retraining or skill enhancement.

Workers’ compensation covers most types of industrial injuries that occur on the job or as a result of work activities or exposure. For example falls, slips and trips, contact with objects or equipment, overexertion or repetitive work, exposure to toxic substances or chemicals, exposure to workplace violence (such as an assault by another employee), and carpal tunnel syndrome (CTS). It also covers psychological conditions known as “mental stress claims,” which can result from been over stressed at work, been bullied, or witnessing workplace accidents or other traumatic events at work, or sexual harassment or discrimination.

Some of the most common medical treatment covered under workers’ compensation may include some of the following:

  • Physical exams, such as X-rays or MRIs
  • Hospital stays
  • Surgery (including plastic surgery)
  • Prescription drugs
  • Physical therapy and other rehabilitation services

To be eligible for workers’ compensation medical treatment, you must have suffered an accepted injury arising out of and in the course of your employment with the employer. There are other requirements as well, but these are the most common ones that apply when claiming medical treatment through the workers’ compensation system. Call Now to get a Free Consultation

What type of medical care am I entitled to?

You are entitled to reasonable medical treatment to cure or relieve work-related injuries and illnesses. In order for medical treatment to be approved by the insurance company, usually, the doctor who treats you must follow certain treatment guidelines referred to as the medical treatment utilization schedule (MTUS).

However, all medical treatment under the workers compensation system is required by law to have a program called Utilization Review (UR). This program is used to decide whether or not to approve a medical treatment recommended by your doctor. If the utilization review denies the medical treatment prescribed by your doctor, there is an appeal process in place called Independent Medical Review (IMR). Speaking with an experienced attorney is strongly encouraged in dealing with denial of medical treatment.

Can I be treated by my regular doctor?

If you predesignated your personal physician or medical group, usually, when you first started your employment with the company, then you can elect to treat with your regular doctor for your work-related injuries.

What if my employer has an MPN?

An MPN is a Medical Provider Network of physicians and other health care providers maintained by the insurance company or the employer to treat injured workers. If you injured yourself at work and if there is an MPN established by your employer, then you will need to find a doctor in their MPN. In doing so, will prevent you from being billed later by an industrial clinic or hospital for treatment provided in connection with a work injury. Therefore, the costs may be paid by the insurance company or by your employer directly. If you are covered by a health plan, you should check with your plan administrator to see if there is any impact on the coverage that you will receive under the MPN.

What if my employee does not have an MPN?

If an employee does not have an MPN, the employer will still be responsible for paying for the medical expenses incurred during work-related activities or through work-related activities. This is so, because injured workers should not have to pay for medical expenses in connection with treatment that are reasonably necessary to treat or relieve the effects of a work injury. But we can help, Call Now

What if I disagree with my treatment and want to change my treating doctors?

If you pre-designated your doctor: You may switch to a different physician at any time. Write to your insurance company to let them know of the change.

If you did not pre-designate your doctor: If your employer has a medical provider network, you may choose a different doctor within the medical network. You are allowed to do so if you inform the insurance provider, the claims administrator, or the claims adjuster, in writing that you are using your right to choose your own doctor and give them the doctor’s name and contact information.


The content and views expressed herein is for information only and may not be accurate AND does not constitute legal advice or legal representation. If you have questions, you should contact our office immediately or should speak with an attorney as soon as possible.

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