Workers' Compensation Medical Care and Resolving Problems

Workers’ Compensation Medical Care and Resolving ProblemsIf you have been injured on the job and have decided to apply for workers’ compensation benefits, you should have no problems receiving the compensation you deserve… right? The problem is that so many people each year are evaluated on their injuries and do not agree with the reports. Different doctors will have different opinions when it comes to things like treatment options, what to do while you recover, and more. But let’s back up a bit and discuss how you can receive a medical evaluation when you have been injured.

  • What if I have an attorney? Your attorney and the chosen claims administrator may come to an agreement about a doctor called an Agreed Medical Evaluator (AME), who is not required to be certified by the Division of Workers’ Compensation (DWC).
  • What if I do not have an attorney? You will receive a letter stating that you disagree with the medical report. From there, the claims administrator must send you a form and instructions on how to select a Qualified Medical Evaluator (QME). You will have 10 days to fill out the form and send it to the DWC.

Doctor Competence and How It Plays a Role
Some doctors who handle workers’ compensation claims are considered to be “fringe” doctors. This means that they may not keep up with the latest medical literature, pursue further education, or be knowledgeable in the latest medical technology. Doctors that work for workers’ compensation know that insurance companies do not like spending money for diagnostics. A doctor might not tell you that he or she recommends those diagnostic tests even if they are necessary. Because of this, you may find that many doctors approved by insurance companies will be more likely to treat injuries with pain medication due to the fact that pills are much less expensive than MRIs.

What Happens if I Don’t Agree With a Treating Doctor?
First of all, you can send a letter to the claims administrator stating that you disagree with the medical report. If the letter is not sent before the deadline (approximately 30 days after you received the report with no attorney and 20 days with an attorney), you may risk losing the right to challenge the treating doctor’s opinion on your claim. Second of all, you could choose to receive a medical opinion or evaluation from another doctor.

Here Are Some Things You Should Know:
You employer is legally required to post information about your workers’ compensation rights. This includes the right to decide who they want your personal physician to be in case of a job injury. You should also be aware of whether or not your employer is involved in the Medical Provider Network (MPN). If they are, the employer or insurer is required to give you written information about your rights, procedures, and services while you are being treated. Lastly, you have a right to request and receive copies of medical reports that will affect your benefits. You also have a right to have another person present during the medical examination or to be able to tape the examination if you alert the doctor first.

If you are planning on filing for workers’ compensation benefits, you will want to know your rights. It helps to have an experienced attorney on your side throughout the tedious and complex process. Call Welebir | Tierney in California today so you can speak to an attorney that you can trust. Schedule a consultation today!


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