Medical Treatment

Are you getting the treatment you need to get well and return to work, or are you getting a run around?

The California Constitution requires the employer to provide treatment “that is reasonably required to cure or relieve the injured worker from the effects of his or her injury.” For details, see Labor Code §4600.
Unfortunately, the injured worker has lost the right to select the doctor he or she chooses, except in limited circumstances. Often you will be required to select a doctor from a medical provider network set up by the employer.

Your Primary Treating Physician (PTP) will designate other doctors to consult, if necessary. Your PTP is required to issue reports. Ask for copies so you know what your doctor is telling the claims adjuster. You have the right to see and have copies of your records.

Besides the blight of the medical provider network, there is the “doctor’s roulette” of the Qualified Medical Evaluator process. See QME page on this website.

Treatment is also limited by utilization review and the necessity of adhering to treatment guidelines. Certain types of treatment — chiropractic, physical, and occupational therapy — have limits imposed by the legislature, no matter how necessary to your recovery. The most number of sessions the employer can be required to provide is 24 of any of these three types, unless you had surgery. See Labor Code §4604.5

Also, remember that you are not required to talk with, or allow into the treatment room, the nurse case manager (NCM). The NCM sometimes acts as an investigator for the adjuster. Be careful what you say. Do not discuss personal matters with the NCM. Tell your PTP you do not want the NCM present while meeting with the PTP or the PTP’s staff. You have a right to privacy.