Medical Treatment Benefits
Under California's workers' compensation law, employees who are injured or become ill due to their job are entitled to medical treatment to cure or relieve the effects of their injuries. Key aspects include:
Coverage:
- All reasonable and necessary medical care is covered, including hospital visits, surgeries, medications, and physical therapy.
- Medical treatment is provided at no cost to the employee, as long as the care is authorized by the workers' compensation insurer or employer.
Initial Treatment:
- After reporting an injury, employees are entitled to receive immediate medical attention. Employers must provide a claim form (DWC-1) and ensure that the employee receives prompt medical care.
Continuing Care:
- Employees are entitled to ongoing medical treatment as long as it is necessary to manage or alleviate the injury or illness. This may include specialist visits, rehabilitation, and long-term care if required.
Medical Provider Network (MPN)
The Medical Provider Network (MPN) is a key component of California's workers' compensation system. It is a network of healthcare providers that are approved to treat workers' compensation injuries and illnesses. Here’s how it works:
Selection of Providers:
Employers and their workers' compensation insurance carriers establish MPNs with selected healthcare providers, including doctors, clinics, and hospitals experienced in treating work-related injuries.
Employee's Choice:
Employees can choose their treating physician from within the MPN. If the employee is unsatisfied with the initial physician, they have the right to switch to another doctor within the network.
Access to Specialists:
The MPN includes a range of specialists to ensure comprehensive care for various types of injuries. If specialized treatment is needed, the primary physician can refer the employee to an appropriate specialist within the network.
Access to Specialists:
The MPN includes a range of specialists to ensure comprehensive care for various types of injuries. If specialized treatment is needed, the primary physician can refer the employee to an appropriate specialist within the network.
Continuity of Care:
If an employee's treating doctor is no longer in the MPN, the employee may continue to receive treatment from that doctor for a specified period under the continuity of care provision, ensuring there are no disruptions in their medical treatment.
How to Use the MPN
After Reporting an Injury:
Once an injury is reported, the employer or claims administrator will provide the employee with information about the MPN, including how to access medical care and choose a provider.
Finding a Provider:
Employees can find MPN providers through the network’s directory or website, which lists all approved doctors and medical facilities.
Changing Providers:
If the employee wishes to change their treating physician, they can do so by selecting another doctor within the MPN, ensuring continuous and appropriate medical care.
Important Considerations
Non-MPN Treatment: If an employee receives treatment outside the MPN without prior approval, they may be responsible for those medical expenses unless it’s an emergency or there are no suitable providers within the MPN.
Pre-Designated Physicians: Employees may pre-designate their personal physician before an injury occurs, provided the physician agrees to treat work-related injuries and the employer is notified in writing.
Resources
For more detailed information on medical treatment and MPNs in California’s workers' compensation system, please refer to:
- California Department of Industrial Relations - Medical Treatment Overview
- California Department of Industrial Relations - Medical Provider Networks (MPN)
- Guide to Workers' Compensation in California
This memo provides an informational guide to understanding Medical Treatment benefits under California's workers' compensation system and it is not intended as legal advice. For any specific legal advice or assistance, please contact our highly competent and knowledgeable attorneys.