In my first post, we covered issues that arise earlier in a case (AWW, TD, PTPs, WPI, RFAs, UR and IMR). Part II covered some of the common issues (and shorthand) that would come up later in a case (P&S, stips, C&R, MSA, F&A). Though uncommon, there are particular issues that might exist in a…
My earlier post covered issues that arise earlier in a case (AWW, TD, PTPs, WPI, RFAs, UR and IMR). Later in a case, you might encounter one or some of the following situations (with their associated acronyms): P&S—Permanent and Stationary A Permanent and Stationary (P&S) determination can be made by a Primary Treating Physician (PTP),…
There are a few things injured workers should expect. Medical treatment and pay for time lost due to the injury among them. Often not expected, however, is the paperwork and regulations buried in a sea of acronyms. Here, we will discuss some of those acronyms along with some relevant notes. TD—Temporary Disability Temporary Disability (TD)…
After a workplace injury, the first thing that might happen is paperwork or an incident report. It might have been a trip to the emergency room. Often, though, an employee is directed to a front-line occupational medical clinic. Some clinics are favored by employers or insurance companies due to lower cost of care. While that's fine for the company paying the bills, the person with an injury can face long wait times, difficulty getting medical reports, and might never meet the treating doctor. It's not uncommon for someone think they're seeing a medical doctor only to finally get the reports and discover they've been seeing a nurse or physician's assistant and never met the medical doctor responsible for their care.
Some providers at an occupational medical clinic might not be as thorough. Treatment requests have to document the medical need for that treatment. If a doctor, nurse, or assistant is not thorough when documenting the medical necessity for that treatment, the request is more likely to be denied. The patient's medical recovery can be delayed or diminished as a result.
It's common for self-insured employers or work comp insurance companies to maintain a Medical Provider Network or MPN. This works a lot like an HMO where an in-network Primary Treating Physician is in charge of referrals to other in-network providers. Once the claim is filed--or when an MPN is being asserted--the claims adjuster should send MPN information including how to get a list of local doctors in network (see 8 CCR sec. 9767.12(a)).
Getting quality care after an injury is important. Helping find that quality care earlier on is one of the ways we help our clients reach a better result following a work injury. If you or someone you know was injured on the job, please call us or click here to request a free consultation.
Workers’ Compensation is defined as a “limited benefits system.” Meaning, unlike a Personal Injury case, where damages can be decided by a judge or jury, “Compensation” under California’s Workers’ Compensation system is limited to the benefits defined by the Labor Code. Labor Code § 3209 makes this point very clearly: ““Damages” means the recovery allowed in an action at law as contrasted with compensation.”
“Compensation” under the Workers’ Compensation act, while more narrowly defined than damages, does have some notable benefits. First, Workers’ Compensation in California is a “no-fault” system meaning an Employee can file a claim without proving employer negligence or any negligence. A claim also survives even if there was negligence on the Employee’s behalf.
Second, unlike a personal injury case which can go for years before there is any award, Workers’ Compensation benefits can start as soon as a claim is filed. Even while a claims examiner is deciding whether to accept or deny liability for a claim, up to $10,000 in medical treatment should be provided (with limitations). If a claim is accepted, Temporary Disability payments are designed to offset lost wages (again, and with all things in Work Comp, with limitations).
A Workers’ Compensation claim can even provide retraining before the case is finalized if the right conditions are met.
All to say while there are significant limitations involved in a Workers’ Compensation claim, qualified and knowledgeable representation can help ensure potential benefits are understood and maximized to the extent available.