Worker’s Compensation

What is Worker’s Compensation?

It is a no-fault medical system that pays for treatment and wages for treatment of an injury that occurred at the workplace. The injury is covered if it happened at work during work activity: from the time you park your car in the parking lot to arrive and leave from work. It is not disability – that is a separate government run system.

How do I file for a claim?

You must file paperwork with your employer – these forms may be obtained from human resources or your manager. Some companies may have their own doctors for work injuries – this field is called Occupational Medicine. Your employer submits the claim to their insurance company – your place of employment does not directly pay for your lost wages or medical care.

Who is a Worker’s Compensation doctor?

Many specialists see Worker’s Compensation patients in addition to traditionally insured patients in their practice, as I do. Some doctors exclusively see Worker’s Compensation patients. Primary care doctors that work exclusively in the Worker’s Compensation system are call Occupational Medicine doctors. In some instances, your company can pre-determine which doctors and specialists you will see. In many cases you are able to pick your specialist doctors if they accept the insurance plan you are covered under.

Do I need a lawyer?

Not necessarily. If your claim is accepted and your doctor’s recommendations have been met, patients can navigate the system easily. In the case that your claim is denied or your doctor’s recommendations have been denied, a lawyer can advise you and assist in navigating the appeal system.

What are the benefits of a Worker’s Compensation claim?

When a claim is appropriate and accepted, the system helps maintain wages even in the case one cannot work or must work with modifications. There are no co-pays as this system is separate from your private insurance. The goal of the Worker’s Compensation system is to get you treated and back to your normal work.

What is authorization?

Authorization is when the Worker’s Compensation insurance company gives permission. You need permission to start care in this system – you cannot show up at a doctor’s office and declare that you injury is covered. Authorization happens after the insurance company processes the claim and agrees to the claim and subsequent treatment. Your doctor’s recommendations must also be authorized for that treatment to occur.

Can I get care outside of the Worker’s Compensation system?

You can get care with your private insurance, but this is called self-procured care. This means you sought private care without authorization from the Worker’s Compensation insurance company and may not be accepted under the claim.

What is permanent and stationary status? And what is future medical care?

When you have reach your maximum recovery from the injury (regardless of your ability to return to your normal work), the case is placed on hold. This means you no longer need to see the Worker’s Compensation doctor on a regular basis. If the doctor feels you will require future care then future medical care can be included in your claim. This allows for treatment of future issues related to your injury. This can potentially be very valuable to a patient if the subsequent medical issues require future surgery. The insurance companies may attempts to buy out future medical care to permanently close the case, and I generally recommend against selling this benefit.


Busfield ORTHOPEDIC Clinic

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