Medical Treatment Authorizations in Workers’ Compensation Claims in California

Maison Law represents injury victims in California, helping them through the workers’ compensation claims process. This process is going to include a visit to a qualified medical evaluator (QME), and that involves providing authorizations to review your medical history and treatment. If you want to talk about your options or learn more, contact us today for a free consultation.

What Authorizations Do You Have to Complete in a Workers’ Compensation Claim?

One of the things you’re going to have to do in the course of your workers’ compensation claim is fill out a range of medical treatment authorizations. The purpose of these authorizations (which are the same authorizations we’ll have you sign for our purposes) is so the insurance company can request your medical records and other relevant information to properly assess your claim.

While it might seem like this a bit invasive, it’s actually required by the Department of Workers’ Compensation (DWC). And while most of the information is going to involve your medical history and records, there’s other authorizations you may have to complete:

• QME authorization – Most likely, you’re going to be required to see a Qualified Medical Evaluator (QME), so you will need to sign an authorization for the QME to access your medical history and records to prepare their report.
  
  
• Medical authorizations – You’ll need to give permission for your medical providers to share your health information related to your injury with the workers’ compensation insurance company. This helps them understand the extent of your condition and the treatments you’ve received.
  
  
• Release of Information (ROI) – This authorization lets the insurance company request your medical records and any other relevant documents from your healthcare providers. This makes sure they have all the information necessary to process your claim.
  
  
• Employment history authorization – You may need to authorize the insurance company to access your employment records. This helps them verify your job duties, work history, and any previous injuries that may be relevant to your current claim.
  
  

Again, signing these authorizations is a standard part of any workers’ comp claim. For the most part, though, our team will collect and provide your medical records and other documentation of your injuries to make your case.

 

What Can You Do to Protect Your Workers’ Compensation Claim During a QME?

One of the good things about a QME and signing medical authorizations is that your medical history and records won’t change. However, there’s always the chance–even possibility–that an insurance adjuster or lawyer for your employer can interpret your medical records. This won’t really factor into your QME in general, but it can factor into how your claim progresses. So, like any other injury situation, you need to take certain steps to protect your claim:

• Be cooperative – Stay calm and respectful during your visit. Being cooperative helps create a good impression and makes the evaluation go more smoothly.

 

• Be honest – Give truthful and accurate details about your injury, symptoms, and how they affect your daily life and work. Don’t exaggerate or downplay your condition, as inconsistencies can harm your claim.

 

• Prepare your information – Get your medical records, symptoms, and treatment history organized before the visit. Having this information handy will help you answer questions clearly.

 

• Ask questions – If you don’t understand something about the exam or the QME process, ask questions. Knowing what to expect will make things a bit more comfortable for you.

 

• Take notes – Write down important points during the visit, especially the QME’s findings and recommendations. This will jog your memory and help you remember key details later.

 

• Follow up on any recommendations – After the visit, make sure to follow any advice given by the evaluator, like getting more tests or treatments. This shows you’re serious about your recovery.

 

Obviously, taking these steps can help you through your QME visit and can also take the step of protecting your entire claim. Our team will keep you informed about the QME visit and its outcome. Then, we can provide guidance on how to proceed with your claim based on the QME’s findings.

What’s the Workers’ Compensation Claims Process Like?

No matter what your injury is, when you file a workers’ compensation claim, it’s going to follow a general outline. Once the accident happens, you get medical care, report it to your employer and file the actual claim, here’s how the process generally plays out:

• Investigating the accident – Your employer’s workers’ compensation insurance company will first investigate your claim. This may include reviewing your medical records and speaking with you and any witnesses.

 

• Medical evaluation – You usually have to see a QME (doctor chosen by the insurance company) to evaluate your injuries and decide on the right treatment.

 

• Benefit decision – The insurance company will determine if your claim is valid and what benefits you can receive, such as medical treatment, temporary disability payments, or job training.

 

• Resolving disputes – If there are any issues with your claim, like disagreements about your injury or disability, you may need to go through a dispute resolution process. This could involve negotiation, mediation, or a hearing.

 

• Return to work – If you’re able, your employer might put your back in your old position, or offer you a job that fits your medical restrictions. If you can’t return to your old job, you might get help finding new work through retraining services.

 

Every situation is different. Some people heal faster than others, while some may have more severe injuries. The key is to understand the process, and remember, our team will be there to guide and support you through your entire claim.

Workers’ Compensation Support From Experienced California Lawyers

While you want to avoid injuries, workplace accidents can happen for many reasons. It’s important to remember that you have legal options to take care of your injuries, whether through workers’ compensation or the legal system. These help you recover things like:

• Medical expenses
• Lost wages
• Disability benefits
• Pain and suffering
• Emotional distress
  
  

At Maison Law, we understand the challenges you and your co-workers face. Your job is vital for supporting your family and helping your employer, but it also comes with risks. If you’re injured at work, we’re here to support you. Our California workers’ compensation lawyers have the experience to guide you through the legal process during this difficult time. Contact us today for a free consultation to get started.