Employees must be paid for the time spent waiting for and receiving medical attention for a work-related injury (e.g., initial doctor visit). In fact, under the California Labor Code, employees are entitled to receive reimbursement for reasonable expenses, along with lost wages, when they submit to an examination by a physician at the request of the employer, the insurer, the administrative director, the appeals board, or a workers’ compensation administrative law judge.
1. Compensating Medical Care
An employee is entitled to reasonable medical treatment to cure or relieve work-related injuries and illnesses. The doctors who treat work-injured employees must follow treatment guidelines referred to as the Medical Treatment Utilization Schedule (“MTUS”).
All employers or claims administrators handling their workers’ compensation claims are required by law to have a program called Utilization Review (“UR”). This program is used to decide whether to approve medical treatment for work-related injuries that an employee’s doctor recommends. For emergency medical care, employers must make sure that employees have access to emergency treatment right away. For non-emergency care, the claims administrator is required to authorize treatment within one working day after a claim form is filed. While investigating the claim, necessary treatment up to $10,000 must be authorized.
2. Compensating Wage Loss
The purpose of temporary disability benefits is to provide a momentary cushion from the effects of workplace injuries.
Generally, temporary disability is payable during the injured worker’s recovery period, starting from the date of injury until the worker has recovered sufficiently to return to work, or until their condition reaches a permanent status. Temporary disability benefits may be total (the injured employee is incapable of performing any kind of work), or partial (the injured employee can perform some work).
Notably, an employer’s showing that modified work is available and offered affects an injured employee’s entitlement to temporary disability.
The first temporary disability payment should be made by the claim’s administrator within 14 days of receipt of the medical report stating that an employee cannot work at all or cannot work the number of hours previously scheduled. The determination of the amount is subject to the injured worker’s capacity to work. Delays beyond the 14-day period are permitted; however, a letter must be sent to the injured employee and a 10% penalty will be added to temporary disability payments. A delay is usually not longer than 90 days.
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