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morgan hill workers compensation lawyerWhen people suffer work-related injuries, they are generally eligible for workers’ compensation benefits. Medical costs related to a work injury, disease or illness contracted while working, or a health condition that was caused by the work a person performed should be fully covered. However, there are a variety of requirements that must be met during treatment, and some limitations may apply. Injured workers will want to make sure to understand their rights and the procedures that will be followed as they receive treatment, and they may need to work with an attorney to make sure they receive the medical benefits they deserve.

Medical Care Covered by Workers’ Compensation

When doctors or other medical professionals provide treatment covered by workers’ comp, this treatment must be evidence-based. It must be scientifically proven to be an effective treatment for the injuries that a person experienced while working or due to their work. The California Department of Workers’ Compensation (DWC) maintains a set of regulations known as a medical treatment utilization schedule (MTUS). This schedule provides guidelines for appropriate treatments for different parts of the body, including those related to post-surgery pain treatment and therapy, as well as acupuncture.

A DWC claims administrator must authorize all forms of medical treatment, and they will perform a utilization review (UR) to ensure that a planned course of treatment is medically necessary. The UR will determine whether treatment recommended by a doctor falls within the guidelines of the MTUS. If the recommended treatment is not included in the MTUS or goes beyond the guidelines, the doctor must provide evidence to the claims administrator showing why this treatment will be necessary and demonstrating its effectiveness. 

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morgan hill workers compensation lawyerPeople who suffer work-related injuries are eligible for workers’ compensation benefits. These benefits cover the costs of medical care, and if an injured worker is required to miss work or suffers a loss of income, they may also receive disability benefits. While temporary disability benefits will apply in situations where a person cannot work or can only work at a reduced capacity for a short period of time, permanent disability benefits may be available for those who have suffered permanent impairments to their ability to earn an income. However, the process of determining the amount an injured worker can receive in permanent disability benefits can be complicated, and it involves the calculation of a PD rating.

How Is a PD Rating Determined?

Before a person can qualify for permanent disability (PD) benefits, a doctor will need to determine that they have reached the point in their treatment where their medical condition is permanent and stationary (P&S). This is also known as maximum medical improvement (MMI). At this point, the doctor will send a report to the Department of Workers’ Compensation (DWC) that specifies the person’s level of impairment using an “impairment number” while also noting whether there were any non-work-related factors that contributed to the impairment.

The DWC’s Disability Evaluation Unit (DEU) will review the doctor’s report and use the impairment number to calculate the person’s percentage of disability. This will indicate the amount of loss of their bodily or mental functions that would affect their ability to return to working in the position they held before being injured. This percentage may then be reduced based on the amount of the disability that was the result of any issues unrelated to the work a person performed. The resulting amount is known as the PD rating, which will be used to determine the total amount of benefits the person will receive for their permanent disability.

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santa clara workers compensation lawyerIn California, employees who are injured on the job are entitled to reimbursement for medical expenses and part of their lost income through workers’ compensation. With some exceptions, anyone who is hurt while performing work tasks is eligible for workers’ compensation or “workers’ comp.” However, some workers’ compensation claims are denied. If you or a loved one applied for workers’ compensation and were denied, a workers’ compensation lawyer may be able to help.

When is a Worker Not Entitled to Workers Compensation?

California workers’ compensation is extensive and covers most individuals. However, there are some exceptions to this generality. For example, if you work in exchange for housing or other aid instead of wages, you do not qualify for workers’ compensation. Individuals who are employed by their parent, spouse, or child in a family business may also be excluded from workers’ compensation. You do not qualify for workers’ compensation if the injury was not related to your job or it occurred when you were off the clock.  

Only workers who are classified as employees are entitled to workers’ compensation. So, if you are an independent contractor, you may not receive reimbursement for your medical expenses or lost income. That being said, many workers who are classified as independent contractors should be classified as employees. A workers’ compensation attorney can help you determine if you have been misclassified.

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