Medical Benefits In Workers’ Compensation
Employers are generally responsible for providing medical care to injured workers free of charge as long as the medical care is related to the work injury, but the methods for doing so vary greatly from state to state.
In some states, employees are free to choose their medical providers as long as the treatment is reasonable and necessary. In other states, the employer directs the medical care.
The question may arise whether certain treatment is related to the work injury or whether it is reasonable and necessary. These are generally medical questions reserved for doctors through utilization review or peer review. Attorneys at Peterson White can help employers and claims professionals with the legal requirements for making these determinations. Missing a deadline or not asking the right questions can result in liability for the treatment even if it is not related to the work injury or not reasonable and necessary.
The length of liability for treatment also varies from state to state. One key is when the injured worker reaches maximum medical improvement (MMI). According to the AMA Guides to the Evaluation of Permanent Impairment, MMI is the point when a condition is well stabilized and unlikely to change substantially in the next year. Even though there may be some change over time, further recovery or deterioration is not anticipated. In some states, the employer must provide treatment only until the employee reaches MMI. In other states, the liability can continue for the employee’s lifetime. For some clients, the possibility of ongoing medical benefits is a reason to settle workers’ compensation claims.
Ongoing medical benefits can cause claims to remain open long after reasonable treatment has finished, sometimes costing adjusters significant time and causing employers and insurers significant money, especially when the injury was so long ago that it becomes difficult to assess the reasonableness or relatedness of the treatment. However, medical benefits can often be closed out later via settlement. Peterson White can help negotiate settlement of open medical benefits for a flat fee.