Medical Treatment for Workers Compensation

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 What Is Workers Compensation?

Workers compensation is a state-mandated insurance program that provides compensation to any employee that has suffered an injury while on the job. An injured employee who is covered by workers compensation, who was injured while on the job, is guaranteed workers compensation benefits regardless of who was at fault for their injury.

It is important to note that in return for workers compensation benefits, employees generally forfeit their right to privately sue their employer in court for damages for their injuries. This means that workers compensation provides an employer protections from private civil liability.

What Are Workers Compensation Benefits?

Examples of the most common workers compensation benefits include:

  • Payment of a replacement income while the employee recovers from their work related injuries;
  • Compensation for the employee’s medical expenses;
  • Payment of rehabilitation expenses for the employee;
  • Long-term or lump sum pension if the employee is permanently unable to return to their work; and/or
  • Payment of a temporary disability pension while the employee is unable to work.

It is important to note that in order to satisfy workers compensation requirements, the injured employee must be an actual employee of the employer. This means that the injured party cannot be an independent contractor or an employee not fully employed by the employer. Additionally, the injured employee’s injuries must be related to the performance of their job duties.

What Injuries Are Covered by Workers Compensation?

Examples of the most common injuries that are covered by workers compensation include:

  • Repetitive stress injuries that are caused by an employee’s performance of their job;
  • Illnesses or diseases that are a result of an employee’s work conditions;
  • Traumatic physical injuries that occurred while the employee was acting in the scope of their job duties;
  • Repeated trauma injuries that occur as a result of the employee’s work;
  • Mental injuries that are associated with an employee’s physical injuries; and
  • Occupational diseases that occurred as a result of the work conditions present.

It is important to note that there are several types of injuries which are not covered by workers compensation, including:

  • Injuries that are self-inflicted, such as injuries caused by an employee starting a fight;
  • Injuries that resulted from the employee’s commission of a serious crime;
  • Injuries that resulted when an employee’s own conduct violated company policy, or injuries that occured when an employee was not acting within the scope of their job duties;
  • Injuries received while an employee was either intoxicated or under the influence of illegal drugs; and
  • Injuries in which an employee was acting in a reckless or dangerous manner.

Who Is Not Covered by Workers Compensation?

There are several classes of employees who are not entitled to workers compensation benefits. The following is a general list of employees that are not typically covered by workers compensation:

  • The owners of the business;
  • Independent contractors;
  • Federal employees;
  • Domestic employees that work in private homes;
  • Certain farm workers;
  • Certain maritime workers;
  • Railroad employees; and
  • Unpaid volunteers or interns.

Once again, workers compensation laws can vary by state. As such, additional employees may be covered by their particular state’s workers compensation laws. Thus, it is important to consult with your local states laws on workers compensation to determine whether or not you are entitled to workers compensation.

How Does an Individual File for Workers Compensation?

In order to file for workers compensation benefits, an injured employee must first report their injury to their employer. Next, their employer will then provide the employee the necessary workers compensation forms to fill out and submit. After an employee receives the workers compensation forms, that employee must then:

  • Seek medical attention for their injuries and follow any doctor’s instructions regarding the treatment plan for their injuries; and
  • Complete and file the worker’s compensation claim with their employer’s insurance company or workers compensation provider.

It is important to note that in some states employers are given an option to be subscribers to workers compensation. This means that employees of non subscribers will not have access to workers compensation benefits. However, non subscribing employers may then be sued privately by any person or employee that is harmed on the job.

What Medical Treatment Is Available Under Workers Compensation Injury?

If you have been injured while on the job, and that job is a subscriber to workers compensation, then part of your workers compensation claim will include the medical treatment for your injuries. In almost every state injured workers are allowed to seek medical treatments that are reasonably required to help them recover for their work related injuries.

Examples of the most common types of medical treatment covered by workers compensation include:

  • Required surgeries;
  • Initial and follow up consultations with general physicians, and in some cases, specialists;
  • Acupuncture treatment;
  • Chiropractic treatment;
  • Treatment that occurs at the hospital;
  • Medicine and prescription costs;
  • Costs for medical and surgical supplies; and/or
  • Medical devices, such as orthodox and prosthetic devices and related service.

It is important to note that in some states there may be a maximum number of allowable visits to specialists such as chiropractors, acupuncturists, or physical therapists. As such, it is important to consult your local state’s laws on workers compensation to determine what exact medical treatment is available and if there are any restrictions on the amount of visits.

Who Chooses the Medical Treatment Provider for a Workers Compensation Injury?

If you have been injured on the job, in many states you must first go through an in network medical treatment provider as established by your employer or their insurance company before you are allowed to utilize or choose your own medical treatment provider. However, in some states an injured employee may choose their own medical treatment provider from the beginning of the treatment process.

This means that there are no restrictions on choosing medical treatment providers in some states. Importantly, in most states an injured employee will eventually be able to seek their own medical treatment provider. However, the medical treatment provider chosen may still be restricted to some limitations, such as geographical area, the type of medical treatment available, and the costs of treatment.

How Much of an Injured Employee’s Medical Treatment Expenses Are Covered?

In general, all of an injured employee’s medical expenses will be covered by their employer if they are injured while performing their job. Most employers are subscribers to workers compensation and have workers compensation insurance to pay the costs involved with the treatment of an injured employee’s treatment.

In many states, employees may even be compensated for their travel expenses from their home to their medical treatment provider. Further, if an employee’s employer is determined to have acted negligently or refuses to timely pay for a covered employee’s medical treatment, they will be liable for additional damages suffered by the employee.

Do I Need a Lawyer for Help With Workers Compensation Law?

If you are seeking workers compensation benefits, it is in your best interest to consult with an experienced workers compensation lawyer. An experienced workers compensation lawyer will be able to instruct you on how to best proceed with your workers compensation claim or private civil personal injury case.

If your employer is not a subscriber to workers compensation, an attorney will be able to help you determine if you are able to recover for the injuries you suffered at the workplace. Finally, an attorney will also be able to initiate a private civil lawsuit on your behalf against your employer, and represent you in court, as necessary.

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