Workers’ Compensation Medical Benefits Attorney in Van Nuys, CA
California workers’ compensation entitles an injured worker to medical treatment reasonably necessary to cure or relieve the effects of the injury, for as long as treatment is needed — there is no dollar cap on medical benefits. Treatment is typically directed through the employer’s Medical Provider Network (MPN), and proposed treatment can be reviewed and disputed through a process called Utilization Review (UR), with disputes escalating to Independent Medical Review (IMR).
Key Points
- Covers doctor visits, surgery, physical therapy, medication, medical devices, and necessary travel to appointments
- The employer or its insurer generally has the right to direct treatment through its Medical Provider Network, at least initially
- A treating physician determines when you’ve reached Maximum Medical Improvement (MMI), also called permanent and stationary status
- Treatment that is delayed, modified, or denied through Utilization Review can be appealed through Independent Medical Review
Considerations
- If medical treatment is delayed or denied, the clock on getting a case resolved can effectively stall — these disputes often benefit from attorney involvement
- An injury caused by treatment for a prior work injury (for example, a bad reaction to a prescribed medication) can itself be a compensable “compensable consequence” injury under California law
- Keeping consistent, detailed records of symptoms and treatment helps substantiate ongoing benefits
California Law Note
California’s Independent Medical Review (IMR) process, created by SB 863, is generally the exclusive method for disputing a Utilization Review medical necessity denial — it is a paper review by an independent physician, not a hearing before a judge, which makes how the initial request is documented especially important.
Related Questions
What benefits am I entitled to after a work injury?
California workers’ compensation generally provides four categories of benefits: medical care (treatment needed to reach maximum medical improvement, with no dollar cap), temporary disability (wage replacement while you can’t work), permanent disability (compensation for lasting loss of function), and a supplemental job displacement benefit (a training voucher if you can’t return to your usual job and aren’t offered modified work).
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