Maison Law represents injury victims in California, including those hurt at work and going through the workers’ compensation process. There’s going to be medical treatment with any injury, but the more serious the injury, the more treatment you’ll need. Costs quickly add up, so you have to consider future medical treatment and ongoing care needs when you think about your legal options. Contact us today for a free consultation to learn more about your options in this situation.
How is Future Medical Treatment Decided in a Workers’ Compensation Claim?
Some injuries that happen to you at work can be taken care of right away, while others may take longer. This is just a reality of the situation, but one of the things you have to think about is how your ongoing medical needs are going to factor into your benefits. California attempts to address this by using what is known as a Medical Treatment Utilization Schedule, or MTUS.
The MTUS sets guidelines for certain injuries based on medical opinions and normal treatment parameters, and is one of the main ways future medical expenses are calculated when deciding benefits. But specifically, the MTUS typically involves the following:
- Evidence-based guidelines – The MTUS is built on research and medical facts. It lists the treatments that are most likely to help injured workers recover. It covers many types of injuries commonly seen in workers’ compensation cases.
- Scope of the treatment – The MTUS outlines what types of treatments are appropriate for different injuries, how often you should receive them, and how long they should last. This includes things like surgeries, medications, and physical therapy.
- Utilization Review (UR) – Employers and workers’ compensation insurance companies check if a doctor’s recommended treatment matches MTUS guidelines. If a treatment isn’t in the guidelines, the doctor may need to explain why it’s necessary for it to be approved.
Like any set of medical guidelines, the MTUS is regularly tracked and updated as technology and treatment improves. While this will be an important part of your future medical needs and the benefits you might get, you also have to look at the overall process. This means knowing what to do when you get hurt.
What Do You Need to Do After Getting Hurt at Work?
You obviously never want to get hurt in any situation, let alone at work. But no matter what job you have, it’s always a possibility. Whether it’s a relatively minor slip and fall or a more serious injury on a worksite, you need to know how to properly respond:
- Take care of your health first – Your health is the top priority. Call 911 or go to a hospital or urgent care as soon as possible for treatment.
- Report the accident to your employer – Let your employer know about the accident and your injury as soon as you can. You have up to 30 days to report a workplace injury, but the sooner you report it, the sooner you can start workers’ comp.
- File a workers’ comp claim – Most workplace injuries are covered by workers’ compensation. Ask your employer for the form, fill it out, return it, and keep a copy for yourself.
- Investigation – The workers’ compensation insurance company will look into your claim by reviewing your medical records and talking to you and any witnesses.
- Medical evaluation – You may need to see a doctor (a QME, Qualified Medical Evaluator) selected by the insurance company to evaluate your injury and recommend treatment.
- Claim decisions – The insurance company will decide if your claim is valid and what benefits you qualify for, such as medical care, temporary disability payments, or vocational rehabilitation.
- Disputes – If there are any disagreements about your injury or benefits, you may need to go through a process to resolve the issue, which could include negotiation, mediation, or a hearing.
- Return to work – If you’re able, your employer might offer you a job that meets your medical restrictions. If you can’t return to your previous job, you might get help finding a new one through vocational rehab services.
Obviously, there’s a lot that goes into the workers’ comp claims process. What’s important for you to remember is that you have options to recover not just your future medical expenses, but your current medical expenses, lost wages, and other things you’re going to need to get better. Our team will be there to guide you through this whole process.
Experienced Workers’ Compensation Lawyers in California
Whenever you’re hurt, it brings a lot of challenges. The more hurt you are, the more care you’ll likely need as you progress forward. Our experienced California workers’ compensation lawyers at Maison Law will be there to support you through this recovery process. To learn more about your options and how we can help you, contact us today for a free consultation.
