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What Medical Treatments Workers’ Compensation Covers

  • Published: June 1, 2021

Workers’ compensation benefits are to help employees who sustained a work-related injury or illness. Many accident victims wonder whether there is a maximum amount of compensation or limits to what treatments they can pursue. Generally, there is no cap on workers’ compensation medical benefits in California as long as you are receiving necessary medical care. 

Workers’ compensation benefits can be challenging to understand. When navigating this process, having the assistance of an attorney will be beneficial. In California, the KCNS Law Group is an excellent source of legal representation when pursuing workers’ compensation benefits. 

What Medical Expenses Does Workers’ Compensation Cover? 

Remember that you might not be eligible for workers’ compensation benefits if your injury or illness occurred when you were off the clock, commuting to work, or intentionally harming yourself. Additionally, there are other steps you must take to ensure you receive benefits, such as notifying your employer within 30 days of the accident. 

If the injury or illness happened on the clock and resulted from your job duties and meets all the requirements, you might be eligible for compensation. This might include medical expenses, lost wages, ongoing care costs, or funeral expenses.

Workers’ compensation might cover the following medical expenses: 

  • Emergency room visits: Depending on your injury, you may need to go to the emergency room. The cost of this alone could be tens of thousands of dollars, but you might be able to get that money back if the accident occurred at work. 
  • Copays: Many healthcare insurance plans include copays for appointments. Paying $50 or so each time you have to see a doctor can quickly add up, especially if you go multiple times a week. 
  • Deductibles: A deductible is the amount of money you must pay for treatment before the insurance covers the rest. The amount will vary depending on insurance, but workers’ compensation should cover deductible costs. 
  • Prescriptions: Doctors commonly prescribe painkillers and antibiotics, but they can be costly. You should not have to pay for initial prescriptions or future refills when your injury or illness occurred while performing job duties. 
  • Surgeries: A medical provider has to deem a treatment necessary for you to reach maximum medical improvement. If they do not deem that, an insurance company can refute the coverage and say it was an elective treatment.
  • Ongoing care: Some work-related accidents may require ongoing care, such as physical therapy, to reach maximum recovery. As long as a doctor recommends it, workers’ compensation should cover the cost. 

In addition to medical expenses, workers’ compensation may also cover lost wages. Depending on the accident, you may be out of work without pay. You still have bills to pay, such as a mortgage, phone bill, and electricity. Workers’ compensation may supplement your income while you recover. 

How to File a Workers’ Compensation Claim in California 

You can file a workers’ compensation claim in California for any injury that requires more than first aid or more time off than the day of injury. Labor Code Section 5400 requires you to notify your employer in writing within 30 days of the injury. However, we recommend notifying a supervisor immediately. 

Your employer will then provide you with a claim form that you must complete and return as soon as possible. On the form, you will state details about the accident and sign the document. Details should include: 

  • The date and time of injury or illness 
  • Address or description of where the accident occurred 
  • Description of the injury and the body parts affected 

Once you complete the form, your employer will then send it to the insurance company for review. At this point, the insurer might contact you and ask for more information regarding the accident. When speaking to them, only provide facts about the accident. Never make assumptions, and do not talk about your injuries. 

Hire an Experienced Workers’ Compensation Attorney in California 

If you are filing workers’ compensation benefits in California, do not hesitate to contact the KCNS Law Group. Our workers’ compensation attorneys will stop at nothing to ensure you receive the maximum amount of compensation for your work-related injuries or illness. To learn more about our services, schedule a free consultation today by calling (818) 937-9255 or complete our online contact form.

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