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What are the guidelines for medical care under workers’ compensation?

Suffering an injury at work can put your life in a tailspin. Luckily, one of the instant benefits you get from workers’ compensation is medical care.

You can seek medical help right away for your injury, and workers’ compensation will cover the costs from the date of the injury forward until you heal. The specific coverage you can receive must follow the set guidelines, though.

Follow the medical treatment utilization schedule

The MTUS dictates what services and treatments a doctor can provide you for a work injury. The doctor must follow these instructions when choosing treatment options and determining how to care for you. Workers’ compensation will not approve treatments not contained within the MTUS.

Approval for doctor choice

You can use your own doctor, but you must predesignate that provider before you suffer an injury. You need to provide your employer in writing a notice including the doctor’s name and business address and specifying you want this doctor to treat you for any work injuries. You also need to have a preexisting relationship with the provider you name.

If you fail to predesignate, the claims administrator can choose the doctor you must use for at least the first 30 days of care. After that, you again have the right to choose your care providers.

If your doctor is part of an MPN, the claims administrator must provide you with a doctor within that organization, and you will have the ability to choose your doctor from the group after your initial visit.

If you are part of an HCO, the HCO will handle your care. That also means choosing your doctors for you.

Following the rules for health care under workers’ compensation is important to avoid having expenses the system will not cover.