Who Pays Your Medical Bills After a Workplace Injury in California?

Getting hurt at work can create immediate concerns about your health, your ability to keep working, and the cost of medical treatment. Emergency room visits, doctor appointments, diagnostic testing, medication, physical therapy, and other forms of care can quickly become expensive. Fortunately, California’s workers’ compensation system is designed to provide medical care for employees who suffer qualifying work-related injuries and illnesses.

In California, your employer is generally responsible for medical care related to a covered workplace injury, typically through its workers’ compensation insurance carrier or through a self-insured workers’ compensation program. The claims administrator handles payment of covered medical bills. California’s Division of Workers’ Compensation states that medical care must be paid by the employer for a work-related injury even when the employee does not miss time from work.

At Jackson & Jackson Law Office, we help injured workers throughout Los Angeles and Southern California understand their rights, pursue appropriate medical treatment, and address disputes that may arise during the workers’ compensation process. Our firm has represented injured California workers since 1971.

What Medical Expenses Does California Workers’ Compensation Cover?

California workers’ compensation provides medical treatment that is reasonably required to cure or relieve the effects of a work-related injury or illness. Depending on the injury and applicable treatment guidelines, covered care can include doctor visits, hospitalization, physical therapy, chiropractic treatment, prescriptions, X-rays, laboratory services, and other necessary treatment.

For example, an employee who suffers a serious back injury while lifting equipment may require diagnostic imaging, medication, physical therapy, injections, or surgery. Someone who develops carpal tunnel syndrome from repetitive job duties may need testing, therapy, medication, or another form of treatment.

The important issue is establishing that the condition is work-related and obtaining authorization for appropriate treatment. Jackson & Jackson Law Office works with injured employees to navigate this process and pursue the medical care and workers’ compensation benefits available under California law.

Should an Injured Worker Receive Medical Bills?

Generally, an injured employee should not be personally billed for authorized medical treatment related to a workers’ compensation claim. The California Division of Workers’ Compensation states that an injured worker should not receive a medical bill when a claim form has been filed and the physician knows the injury is work-related. California law also prohibits a physician or medical facility from billing a worker when they know the injury is or may be work-related.

This makes it important to tell medical providers that your injury occurred at work and to follow the proper workers’ compensation claim procedures.

If you begin receiving bills for treatment connected to your workplace injury, do not simply assume that you are responsible for paying them. There may be an issue with how the treatment was billed, whether the provider has the correct workers’ compensation information, or whether the insurance carrier has disputed or delayed treatment.

Our attorneys at Jackson & Jackson Law Office can review what is happening with your claim and help you understand the steps available to address medical treatment and billing issues.

What Happens While Your Workers’ Compensation Claim Is Being Reviewed?

A worker may need medical care before an insurance carrier has made its final decision about a claim. California provides certain protections during this period.

According to the California Division of Workers’ Compensation, an injured employee may be entitled to up to $10,000 in medical treatment under applicable treatment guidelines while the claims administrator considers whether to accept or deny the claim.

Because delays can affect both your recovery and your workers’ compensation case, it is important to report a workplace injury promptly and complete the appropriate claim paperwork.

Jackson & Jackson Law Office helps injured workers understand what to expect at each stage of a claim and works to address problems that may interfere with obtaining appropriate medical care.

Can the Insurance Company Deny Recommended Medical Treatment?

Not every treatment recommended by a physician is automatically approved. California workers’ compensation claims administrators use a process known as utilization review to determine whether requested medical treatment meets applicable treatment guidelines. A treatment request may be approved, modified, or denied. Depending on the circumstances, an injured worker may have options to challenge a decision involving medical treatment.

Disputes over medical treatment can be particularly frustrating when an employee is already dealing with pain and uncertainty about returning to work.

At Jackson & Jackson Law Office, helping injured workers obtain authorization for their claims and medical treatment is an important part of our workers’ compensation practice. We can help clients understand the process and pursue the benefits available for their particular circumstances.

What if You Paid Medical Expenses Yourself?

If an employer neglects or refuses to provide reasonably necessary treatment, California Labor Code Section 4600 provides that the employer may be liable for reasonable treatment expenses incurred by or on behalf of the employee.

However, reimbursement can depend on the circumstances surrounding the treatment and the workers’ compensation claim. Before assuming that an expense will or will not be reimbursed, consider speaking with a workers’ compensation attorney about your situation.

Keep copies of medical bills, receipts, prescriptions, correspondence with the insurance carrier, and other documents associated with your treatment. Organized records can help clarify what treatment you received and what expenses were incurred.

Who Chooses the Doctor After a Workplace Injury?

The rules governing where an injured worker receives treatment can vary. In many cases, an employer or workers’ compensation insurer may have a Medical Provider Network (MPN). There are also circumstances in which an employee who properly predesignated a personal physician before the injury may receive treatment from that doctor.

Choosing and changing treating physicians can become an important part of a workers’ compensation case, particularly when an injury requires ongoing treatment or care from physicians in different medical fields.

Jackson & Jackson Law Office assists clients with the medical aspects of workers’ compensation claims and works to help injured employees obtain appropriate care for their conditions.

Medical Care Is Only One Part of a Workers’ Compensation Claim

Although medical treatment is often an injured worker’s immediate concern, California workers’ compensation may provide additional benefits depending on the circumstances. These can include temporary disability payments when an injury prevents an employee from performing their usual job, permanent disability benefits when an employee does not completely recover, and other benefits available under California law.

Some workplace accidents may also involve a potential claim against a third party other than the employer. Jackson & Jackson handles workers’ compensation as well as personal injury and third-party claims and understands how these claims may interact following a workplace accident.

Having the complete circumstances of an injury reviewed can help an employee understand the different sources of compensation that may be available.

Speak With a Los Angeles Workers’ Compensation Attorney

You should be able to focus on recovering from a workplace injury rather than wondering how necessary medical care will be paid. If you are struggling to obtain treatment, receiving medical bills, dealing with delayed authorization, or facing another problem with a California workers’ compensation claim, Jackson & Jackson Law Office is ready to help.

Our firm has been representing injured workers in Southern California since 1971 and assists clients with medical treatment, workers’ compensation benefits, and disputes throughout the claims process.

Call Jackson & Jackson Law Office at 714-942-4655 to schedule a free consultation and discuss your workplace injury and workers’ compensation claim.