Understanding Your Medical Treatment Rights
Our Approach to Workers Compensation Medical Treatment
Navigating medical care after a workplace injury requires strict adherence to California workers’ compensation guidelines. Whether your claim has been accepted or temporarily denied, you need to understand your medical treatment rights no matter the treatment you receive.
Injuries denied by the insurance company can be treated within a lien network of doctors who have agreed to treat injured workers on a lien basis. A lien claim is then filed on the case for medical treatment, and the insurance company pays, adjusts, and/or litigates the medical treatment lien. You will still receive all the benefits you are entitled to receive, but it may take longer if the injury is denied.
When the Insurance Carrier Accepts Liability
If the insurance company accepts responsibility for your workplace injury, your medical care is governed by two primary regulatory frameworks:
Medical Provider Network (MPN): You will generally be required to receive treatment from a physician listed within the insurance carrier’s approved network of doctors.
Utilization Review (UR): This is the mandatory process insurance companies use to review your doctor’s treatment requests and determine if they meet legal definitions of “medical necessity.”
Learn more in our newest blog post: Basics of Medical Care: Workers’ Compensation
What Happens if Treatment is Denied?
If the insurance carrier’s Utilization Review denies, delays, or modifies a specific medical treatment or medication recommended by your physician, you have the right to challenge the decision. Our office files an immediate objection through the Independent Medical Review (IMR) process to have an independent third-party medical professional review and potentially overturn the denial.
When the Insurance Carrier Denies the Injury Claim
A claim denial does not mean your medical care must stop. If the insurance company denies liability for your injury, we can transition your care to an established network of physicians who agree to treat injured workers on a lien basis.
Under a lien agreement, medical professionals provide necessary treatment without upfront costs to you. A medical lien is then filed against your case. Our firm subsequently litigates, adjusts, or negotiates these liens directly with the insurance carrier during the resolution of your case, ensuring your treatment continues while your claim is pending.
Secure Legal Representation for Your Recovery
Delays and denials in medical treatment can permanently impact both your physical recovery and the valuation of your workers’ compensation case. To ensure your medical rights are fully protected, please submit your case details for evaluation.