Key Takeaways:
- California employers must carry Workers’ Compensation insurance to cover job-related injuries.
- All reasonable and necessary medical treatment is paid by the employer’s insurer, not the injured worker.
- Your employer must provide a claim form within one working day of learning about your injury.
- Emergency care must be authorized immediately; non-emergency treatment must be authorized within one working day of filing a claim.
- If a claim is disputed, up to $10,000 in medical treatment must still be authorized during the investigation.
- You should never pay out of pocket for work injury treatment — contact a lawyer if you are receiving bills directly.
A workplace injury can happen in an instant, and the medical bills that follow can be overwhelming. If you have been hurt on the job, you may be wondering who is responsible for covering your treatment costs. Under California’s Workers’ Compensation system, the answer is clear: Your employer is required to pay for all reasonable and necessary medical care related to your work injury, typically through their Workers’ Compensation insurance policy.
Who Pays the Medical Bills?
In California, employers are legally required to carry Workers’ Compensation insurance. When a workplace injury is reported and the claim is accepted, the employer’s insurer, through a claims administrator, becomes responsible for covering your medical expenses. If your employer is self-insured, they handle these costs directly. Either way, you should not be personally responsible for paying out of pocket for injury-related treatment.
Covered medical expenses typically include doctor visits, hospital stays, surgeries, prescription medications, physical therapy, and any other treatment deemed medically necessary to cure or relieve the effects of your injury.
How Does the Process Work?
After a workplace injury, your employer must provide you with a Workers’ Compensation claim form (DWC-1) within one working day of being notified. Once you file the form, the claims administrator has one working day to authorize initial medical treatment. For non-emergency injuries, you will generally need to see a doctor within your employer’s Medical Provider Network (MPN) unless you have pre-designated your own physician.
In the case of a medical emergency, your employer is required to ensure you have immediate access to emergency care, and those bills must be covered regardless of whether the claim has been formally approved.
What if My Claim Is Delayed or Disputed?
While your claim is under investigation, the insurer must still authorize up to $10,000 in medical treatment. If your claim is ultimately denied, you have the right to appeal the decision. In the meantime, you may need to use your personal health insurance to cover bills, though Workers’ Compensation should reimburse those costs if your claim is later approved.
If you receive medical bills directly from a provider, do not ignore them. Notify your claims administrator immediately, as providers are required to bill the Workers’ Compensation insurer, not the injured worker.
Frequently Asked Questions:
Do I have to use my employer’s doctor?
In most cases, yes. California’s Workers’ Compensation system requires injured workers to treat within the employer’s Medical Provider Network (MPN). However, if you pre-designated your personal physician in writing before the injury occurred, you may be able to see your own doctor.
What if my employer does not have Workers’ Compensation insurance?
Employers who fail to carry Workers’ Compensation insurance are breaking the law. You may still be able to recover medical benefits through California’s Uninsured Employers Benefits Trust Fund (UEBTF), and your employer may face significant penalties.
Can I be reimbursed for mileage to medical appointments?
Yes. California Workers’ Compensation covers reasonable travel expenses to and from medical appointments related to your work injury, including mileage reimbursement.
What if my Workers’ Compensation claim is denied?
A denial is not the end of the road. You have the right to appeal through the Workers’ Compensation Appeals Board (WCAB). An experienced Workers’ Compensation lawyer can help you challenge a denial and protect your right to benefits.
Our Rancho Cordova Workers’ Compensation Lawyers at Walters & Zinn, Attorneys at Law, Are Here to Help if You Have Been Injured on the Job and Are Seeking Compensation
If you have been injured at work and are struggling with medical bills, we can help. Our Rancho Cordova Workers’ Compensation lawyers at Walters & Zinn, Attorneys at Law, have the experience to protect your rights and help you secure the benefits you deserve. For a free consultation, call us today at 916-610-4706 or complete our online form. With office locations in Folsom and Fairfield, California, we proudly serve clients in the surrounding areas.