When an injury occurs on the job, many employees and employers are unaware of the law and procedures that are to be followed. Employees are often given incorrect information or partial information that does not fully explain the rights of an injured worker on the job.
You don’t have to go to the Company Doctor.
That’s right. This rule applies only to the first 30 days in regards to seeing the company doctor. If after 30 days you can change doctors and you have the right to choose your own doctor. You don’t need to discuss it with your employer, the insurance company or the doctor. When you choose a different doctor, they are required to notify the insurance company through a “Doctors First Report”. So you can just call any doctor and schedule an appointment.
During the first 30 days after a work injury, you can also request a doctor of your choice. This includes a doctor of chiropractic. The employer or the insurance company for the employer must provide to you within five days the name to a doctor of your choice, and they have to pay for those services.
Did you also know that…
You can change primary treating doctors more than once after the first 30 days
You can change primary treating doctors more than once after 30 days? This is often unknown, but true. In fact, you can change as many times as is considered reasonable and the insurance company would be obligated to pay for the care in most circumstances.
There is more…
If the employer fails to properly post certain notices required by law, the injured worker can go directly to the doctor of their choice and the employer loses the right to control medical treatment during the first 30 days.
You Don’t Have To Always Get Authorization From The Employer Or Insurance Company To See Another Doctor Of Your Choice.
You only need to get authorization during the first 30 days. After that, the doctor is the one who would authorize or not authorize care based on his or her findings during your appointment at the consultation and examination. Labor Code 4600 reads essentially in part that the employers shall (emphasis added) provide the injured worker all reasonable and necessary medical (Chiropractic, Physical Therapy, etc.) treatments to cure and/or relieve the effects of the industrial injury. In other words…
By Law, The Employer or The Employer’s Insurance Company is Required To Pay For Care Deemed Reasonable And Necessary To Cure Or Relieve Your Condition.
And another thing…
YOU WILL NOT LOSE YOUR JOB IF YOU REPORT AN INJURY
The consequences of an employer terminating employment of an injured worker are great. Civil and sometimes criminal penalties can result and damages to employers can be very high, indeed.
Employers who routinely terminate employees who file for Worker’s Compensation Benefits may be investigated by the Division of Worker’s Audit and Enforcement Unit. This unit insures that employers and insurance companies are following the law.
By Law, It Is A Unacceptable Practice To Fire An Employee For Filing A Legitimate Worker’s Compensation Claim.
The law states that it is a felony to file a fraudulent Worker’s Compensation claim, but it also states that to deny someone Worker’s Compensation benefits who is entitled to them is also a felony. Therefore, it works both ways. If the employer violates the law, they are in jeopardy. If the employee is lying or making up a claim for Worker’s Compensation, then they are also liable. Further, attorneys, insurance companies, doctors, vocational rehabilitation specialists and others involved in Worker’s Compensation are also held to the same level of accountability.
Injured Workers Who Don’t File A Claim Upon Knowledge Of A Work Related Injury Are Putting Their Own Rights In Jeopardy.
If you are concerned about losing your job or some other penalty of discrimination for filing a Worker’s Compensation claim, don’t be. If you think you have a work-related injury, see a doctor. Go to someone with the experience, expertise, and knowledge of the ever-changing labor codes. Be honest. Get the facts straight. Explain the type of work you do and be forthright and you shouldn’t have any problems at all.
If I File A Work-Related Injury, I Won’t Have Any Money.
If you have a work-related injury and your Doctor takes you off work, you will be entitled to disability benefits. There are several different types of disability benefits. They include temporary total disability, meaning that you are temporarily totally off work unable to do your job. The most common, though, is what is called temporary partial disability, meaning for a short time, you are unable to do part of your job, say heavy lifting for an example because you hurt your back.
In most situations, the employer will commonly make work arrangements for you to perform light duty or other jobs not causing further injury or aggravation to your back.
If, however, you are permanently injured, you may receive long-term disability benefits and also be trained for a new line of work. Being trained for a new line of work is called vocational rehabilitation. This essentially means that you are trained in a new line of work or profession that does not aggravate or cause further injury to your condition. For example, a typist who has carpal tunnel syndrome may be trained as a supervisor, which no longer requires typing.
The type of disability you have and whether or not you need vocational rehabilitation is determined by professionals in Worker’s Compensation, mainly your doctor and a Worker’s Compensation vocational rehabilitation specialist.
If you are hurt on the job and are unable to work, normally within 15 days you will receive a check amounting to approximately two-thirds of your normal pay up to certain limitations. Most injured workers who are on temporary disability are paid these benefits without much problem.
The Insurance Company/Employer Says I Have To Go To Their Doctor …
What Do I Have To Do?…
In some cases, this may be true. According to a section of Labor Code 4050, the employer is entitled to have the employee evaluated by their own doctor at reasonable intervals. This is to insure that the treatment that the patient is being given and the reports that the insurance company is receiving are verifiable by another doctor’s opinion, examination, and review.
Typically, the insurance company is paying for your care and they want to insure that they are getting their money’s worth. Unfortunately, however, sometimes this leads to situations where the employer to the insurance company for the employer tries to dictate to the patient the care that they should by receiving. As we discussed earlier, the first 30 days of care we will allow the employer to have some right of control based on certain circumstances. But after 30 days, the employee has control of their own care. In most cases, patients like having control of their own treatment and seeing doctors that they think are appropriate for their treatment.
If you Are Being Told That You Cannot Continue With Your Doctor, Or If You Have To See Another Doctor, Discuss This With Your Treating Doctor First.
Patients who have feuds and upsets in this area are best advised after talking with their doctor to consider the reason behind the insurance company requesting treatment with another doctor. In some circumstances, it is quite legitimate. For example, your doctor may not be familiar with Worker’s Compensation law or not reporting regularly or providing treatment which has not shown much benefit in terms of you improving or going back to work.
On the other hand, sometimes this is just an attempt by the insurance company to try to regain control of your medical care, chiropractic care, orthopedic care, etc.
So essentially, there are legitimate reasons for requesting treatment with another doctor and there are non-legitimate reasons. The best advice is to consider all the options and make a decision. The Worker’s Compensation system in the State of California can be very adversarial at times towards patients, employers, doctors, and insurance companies.
The main idea behind all the laws was to give injured workers certain benefits, such as medical care, disability and retraining if they are injured on the job and need of such services.
The Great Compromise
Employees give up rights, such as their ability to sue their employer for negligence and other legal remedies due to the Worker’s Compensation law. So in essence, the law was a great compromise to employers and employees to deal with Worker’s Compensation with work injuries on the job. As in all medical and legal matters, there are exceptions to all of these rules, one being for example, federal employees which do not fall under State of California guidelines.
This article is designed to give you a general idea of how the rules are in most cases and give you some information relevant to the common issues injured workers have. If you have specific legal questions, it is always wise to research the law or consult an attorney who specializes in Worker’s Compensation.