Cramer and Martinez

Free Consultation408-848-1113

7459 Monterey St., Suite A, Gilroy, CA 95020

Gilroy Workers' Compensation Medical Benefits Attorney

Salinas workers' comp medical care benefits lawyer

Lawyer Helping Employees Obtain Medical Care Compensation for Work-Related Injuries in Santa Clara County

California law requires employers to provide workers' compensation benefits to employees who are injured on the job. These benefits cover, among other things, the cost of all medical care deemed "reasonably required to cure or relieve" the injury based on accepted medical science and guidelines. However, the process of obtaining authorization for treatment often involves a complicated interplay between you, your employer, their workers' compensation administrator, and healthcare providers, and this can be difficult to navigate on your own.

At Cramer & Martinez, LLP, we can be your guide and legal representative throughout the process. With more than 20 years of combined experience, we know how to help you keep the process moving so that you have timely access to care, and we will stand up for your rights if you face obstacles to obtaining the benefits you need.

Medical Care Covered By California Workers' Compensation

Depending on the nature of your injuries and their effects, you may be entitled to benefits that cover a wide range of medical care, including but not limited to:

  • Emergency care
  • Transportation
  • Surgery
  • Hospital care
  • Outpatient services
  • Medication
  • Chiropractic care
  • Acupuncture
  • Physical and occupational therapy

If emergency care is necessary, it should be arranged immediately by your employer as soon as they know of your injury. Other forms of care and treatment must be authorized by your employer's benefits administrator after you submit a claim form describing your injuries. Some types of care may be covered without limits if there is medical justification, but for some forms of rehabilitative care like chiropractic care and physical therapy, you may be limited in your approved number of visits.

Working With Your Primary Treating Physician

Your primary treating physician is the person who will be responsible for diagnosing your injuries and recommending treatment, as well as filing reports on your condition and work limitations throughout the treatment and recovery process. The primary treating physician can be chosen in one of a few different ways:

  1. You may predesignate a physician in writing with your employer before an injury occurs, provided that you have health coverage for injuries and conditions unrelated to your work, and that your provider agrees in advance to care for your potential work-related injuries.
  2. If your employer has a medical provider network (MPN) or a contract with a health care organization (HCO) for employee injuries and you have not predesignated your own provider, you can choose a primary treating physician who is included within the network or plan.
  3. Your employer's benefits administrator can select a primary treating physician if there is no MPN or HCO in place and you have not predesignated.

If the option is available to you, predesignating gives you the greatest control of the care you will receive and the physician you will be working with. You also have the right to request a change in your primary treating physician if you are unsatisfied with the one your employer provides.

Overcoming Obstacles to Getting Medical Care Benefits

In some cases, obtaining authorization for your medical treatment is a smooth process. However, you may find that you disagree with either the opinion of your treating physician, the decision of your employer's claims administrator, or both. Hiring a workers' compensation attorney can help you take the steps to overcome these obstacles.

If your dispute is with your primary treating physician, whether it regards their assessment of your treatment needs or your work restrictions, we can guide you through the process of requesting a change in your doctor, seeking a second or third opinion, or requesting an independent medical review. If your claim is denied outright by your employer's administrator, we can help you file an appeal and prepare for your hearing. In any case, we will make sure that you meet all of the necessary deadlines and that you have detailed records of the claims and treatment process that we can use to support your position.

Contact a Salinas Workers' Compensation Lawyer

If you need an attorney to help you secure your medical care benefits, we can help. Contact us today at 408-848-1113 for a free consultation. We serve clients in Santa Clara County, San Benito County, Monterey County, Santa Cruz County, and the surrounding areas, including Gilroy, Morgan Hill, Hollister, Salinas, Watsonville, Los Banos, and San Jose.

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