Work Related Injury and Worker's Compensation

If you get hurt or sick because of work, your employer is required by law to pay for workers' compensation benefits. Workers' comp insurance provides six basic benefits: Medical care, Temporary Disability benefits, Permanent Disability benefits, Supplemental Job Displacement benefits or Vocational rehabilitation and Death benefits.

Workers' compensation is the nation's oldest social insurance program: 

It was adopted in most states, including California, during the second decade of the 20th century. It is a no-fault system, meaning you don't need to prove your injury was someone else's fault in order to receive benefits.

The workers' compensation system is based on a trade-off between employees and employers. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries no matter who was at fault and, in return, are prevented from suing their employers over those injuries.

The vast majority of workers' compensation claims are resolved without any problems. However, sometimes a disagreement can arise between you and the claims administrator over issues such as whether your injury was sustained on-the-job or how much in benefits you are entitled to receive.

When a dispute like that arises, the Division of Workers' Compensation can help resolve it through its Information and Assistance Unit or by going before a judge at one of the division's 24 local offices.

Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.

To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body regions guidelines adopted from the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain, and therapy after surgery. The Division of Workers' Compensation also has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.

Copies of the ACOEM guidelines are available for review at your local DWC office. Other guidelines not adopted from ACOEM can be reviewed and downloaded from the DWC Web site:

https://www.dir.ca.gov

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Copies may also be obtained from:

Division of Workers' Compensation
Medical Unit
 P.O. Box 71010
Oakland, CA 94612-1486

Additionally, employers are required to have a program called utilization review (UR), which basically provides a way to double check that your doctor's treatment plan is sound. Check out our fact sheets and guides page and click on fact sheet A for more information on UR.

Many employees now have their workers' comp injuries cared for by a doctor in a medical provider network (MPN) or a health care organization (HCO). These networks of doctors are similar to health maintenance organizations (HMOs). If you are covered by an MPN your work injury will be taken care of by a doctor in the network unless you qualified to pre-designate your personal physician and did so prior to being injured.

For More Information and your rights click here:

 

http://www.dir.ca.gov/dwc/WCFaqIW.html