How does medical urgency factor in with workers’ compensation?

| Nov 22, 2018 | Workers' Compensation

For workers in California who suffer an injury on the job, workers’ compensation benefits are a key factor in their ability to survive while they are unable to work. Understanding the workers’ compensation process is beneficial to getting the necessary treatment as quickly as possible.

Determining whether a medical situation is urgent is a foundational issue of the process. A utilization review must be completed, and a claims administrator can approve treatment for the injured worker. If a medical case is deemed urgent, this means there will be serious health implications if treatment is not given and the applicant’s ability to recover can be negatively impacted if there is a delay. In an urgent case, the decision regarding treatment cannot take more than 72 hours after the information is received by the claims administrator. The decision must then be communicated within 24 hours.

When the medical condition is not urgent, the decision must be made within five days after a physician has given the claims administrator a request for authorization and information that is required for the decision to be made. In some cases, the claims administrator might require more time to gather the information. If this is the case, the claims administrator will have 14 days after the request was made to make the decision. This decision must be communicated within 24 hours.

Given the problems an injured worker can face, it is important to know if treatment will be provided. Having help from a law firm that is experienced in all aspects of workers’ compensation can help with a case if there is a disagreement at any point.


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