When workers get hurt on the job, they often worry about their medical benefits. They might wonder if there’s a limit on these benefits and if it’ll be enough to cover their gradual healing. This question is not just a matter of policy but a critical concern for those injured at work, as it can significantly influence their journey to recovery.
Fortunately, there’s no cap on medical benefits for workers’ compensation in California. However, some rules and restrictions apply to the kind of medical treatment covered.
If workers get injured, they can get benefits under the workers’ compensation law. This law covers all reasonable and necessary medical treatments for work-related injuries or illnesses. This includes:
- Visits to the doctor
- Any necessary services provided by the hospital
- Surgical procedures
- Prescribed medications
- Lab tests or X-rays for one’s monitoring or diagnosis
- Physical therapy sessions
- Medical equipment like crutches or wheelchairs
- Travel expenses related to medical appointments
Working toward recovery doesn’t come with the burden of co-pays or deductibles. The workers’ compensation insurance company takes care of every expense for their medical care. This allows workers to focus solely on healing and recovery.
The extent of the injuries
While there’s no set limit on the amount of benefits, there are steps in the process that could sometimes act as obstacles to a worker getting the full recovery they need. For instance, an injured worker might expect to receive medical benefits seamlessly, but this may not always be the case. The workers’ compensation insurance company may use a Utilization Review (UR). This is a process where they check if the medical treatment planned for the worker’s injury is necessary and is the right approach, according to well-established medical guidelines and evidence.
Although sometimes the UR process leads to a denial of the worker’s treatment, it doesn’t mean that’s the final decision. The worker can fight this result by making an appeal to the Independent Medical Review (IMR). Even though there’s no maximum cap on the benefits, there might be potential roadblocks that could impede a worker’s recovery. However, with the correct information, workers can tackle these challenges and get the medical benefits necessary for a thorough recovery.
