Medical attention in cases of workers’ compensation.

What kind of medical care will I receive for my injury?

Physicians must provide evidence-based medical treatment. That means they must choose scientifically proven treatments to cure or alleviate work-related injuries and illnesses. Those treatments are presented in a collection of guidelines that provide details about which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the degree of treatment (intensity) and for how long (duration), between other things.

 

The claims administrator has not yet accepted or denied my claim, but I need medical attention for my injury now. What I can do?

The claims administrator must authorize medical treatment within one business day after you submit a claim form to your employer, even while your claim is being investigated. If the claims administrator does not authorize treatment immediately, talk to the supervisor, another person in management or the claims administrator about the legal requirement for immediate medical treatment.

 

Are there limits on certain kinds of treatment?

Yes, it is limited to a total of 24 chiropractic consultations, 24 physiotherapy consultations and 24 occupational therapy consultations, unless the claims administrator authorizes additional consultations or you have recently had surgery and need post-surgical physical medicine.

 

How long can I continue receiving the treatment?

As long as it is medically necessary. However, some treatments are limited by law and the medical treatment you receive must be based on evidence.

If the treatment your doctor wants to provide goes beyond what is recommended, your doctor must use other evidence to show that the treatment is necessary and effective.

In addition, your doctor’s treatment plan may be reviewed by a third party hired by the claims administrator. This process is called Utilization Review (UR). All claims administrators are required by law to have a UR program. They use UR to decide whether to approve the treatment recommended by their doctor.

What is the utilization review?

The UR is the program that claims administrators use to ensure that the treatment you receive is medically necessary. All claims administrators must by law have a utilization review program. This program will be used to decide whether to approve the medical treatment recommended by your doctor.

What is a network of medical providers?

A network of medical providers (Medical Provider Network – MPN) is a group of medical service providers established by your employer’s insurance company to provide treatment to workers injured on the job. Each MPN includes a mix of doctors specialized in occupational injuries and doctors with experience in general areas of medicine.

 

What is a primary doctor?

Your primary doctor is the doctor fully responsible for the treatment for your injury or illness. Usually your employer selects the PTP that you will see during the first 30 days, however, under specified conditions, you can be cared for by your private physician or previously designated medical group.

Leave a reply