MEDICAL
TREATMENT

According to California law, where it is admitted that you have sustained an injury, the employer’s insurance carrier specifies the treating doctor for the first 30 days (unless you filed your choice of doctor with your employer prior to sustaining an injury).

After the initial 30-day period, the employee/attorney for an employee can choose whatever doctor he/she wishes to see.

Unfortunately, the employer and insurance carrier are well aware of the power that goes along with freely choosing a new treating physician 30 days after the injury. Therefore, it is common to see the employer/insurance carrier’s doctor release the injured employee back to work before the 30-day time period has elapsed.

If you do not feel better and are being threatened with release by the company or defense doctor before 30 days have passed, you should do everything in your power to have that doctor continue your treatment and keep you off work beyond the initial 30-day period.

Once 30 days have passed, you can choose any doctor you wish for your treatment. Most of the time, it is advisable to use one of the applicant doctors that we recommend, since these doctors are well versed in workers’ compensation terminology and will submit appropriate reports. Whatever doctor you choose for treatment must provide regular reports to the insurance company along with appropriate billings.

When you see any doctors, you must tell them all your complaints, no matter how small. You must remember the value of your case is based upon the amount of permanent disability you have when your condition has stabilized. Unlike other types of resolution, if you have recovered completely by the time your workers’ compensation case is ready for resolution, there will be little or no value to it. Therefore, It is crucial that, when you see a doctor, you spell out the full range of disabilities from which you suffer, indicating any difficulty or restriction you have when bending, lifting, pulling, pushing, reaching, stooping, positioning your body or using your limbs while working.

If the workers' compensation insurance company is disputing your claim, or if it is disputing the medical treatment you are receiving as reasonable and necessary to treat the effects of your industrial injury, you will have to turn to an alternative means of paying medical bills until your workers' compensation case is resolved. Usually, the doctor to whom we refer you will provide medical treatment on a lien basis, with the expectation that they will be reimbursed out of the proceeds of your case when it is settled. However, you should provide any group insurance information to these or any other doctors with whom you are receiving treatment from.

If the workers' compensation carrier is denying payment of your medical bills, your group insurance carrier may pay those bills and file a lien against your workers' compensation case for reimbursement by the defendant. If they do not, you should inform Goodchild & Duffy immediately by sending the original bill to our office, with a note saying your group insurance carrier is refusing to pay, since you may have other rights such as a claim for bad faith.

Quite often by the time you are seen in this office, you have had treatment with other doctors who have billed your group insurance carrier. It is extremely important that you provide us with any paperwork, bill, etc., that you might have which indicates which entity took financial responsibility for the medical treatment for your work-related injury (other than the workers' compensation insurance carrier for your employer) at the time of the injury.

In most cases, the leverage created by having large medical bills paid by another insurance company becomes an effective bargaining tool when negotiating the settlement of your workers' compensation claim.

You may be entitled to round trip mileage reimbursement for visits to any defense medical examination. You may be also entitled to recoup mileage costs for travel to and from treating doctor offices. The current rate of mileage reimbursement is $.34 per mile.

To receive mileage reimbursements, you must keep a detailed Mileage Log including Your Name, Your Insurance Claim Number, Your Address, Date of Visit, Name of Doctor, Doctor’s Address, and Total Round Trip Miles. (Your Goodchild & Duffy intake packet includes several blank Mileage Log forms.) Once a month, send a copy of your Mileage Log to the insurance company. Be sure to keep the original copy of the Mileage Log for your records.

If and when it is determined that your industrial injury is compensable, and the medical treatment you have received is necessitated on an industrial basis, a claim can be made for reimbursement for mileage to and from the treating doctor.

If the insurance company refuses to pay your mileage reimbursement, this issue will be addressed by the parties when your case is next set for hearing before a workers’ compensation judge.

If your case is resolved by a settlement, ordinarily the settlement amount will take into consideration your claim for mileage reimbursement, if needed.

If you are forced to pay out-of-pocket expenses for medical treatment, medication, etc., you should keep a record of expenditures with the date, medical provider and amount. Attach all receipts and a copy of any prescriptions from the doctor who recommended said expenditure. Mail a copy of these records to our office or bring them with you to any workers' compensation appeal board hearings or conferences and give them to your attorney at that time.

We hope this information will be helpful to you.

Please contact us for a free consultation:

LAW OFFICES OF GOODCHILD & DUFFY
16133 VENTURA BLVD., #1250
ENCINO, CA 91436