Worker's Compensation Frequently Asked Questions
Answer: In certain circumstances the opinion of your primary treating physician is presumed to be correct - as to the level of your permanent disability and the type of care you are to receive in the future. Thus, any injured worker should choose to treat with a physician he or she believes to be both caring and competent. A favorable opinion from the treating physician, helps to speed the final result in most cases.
Most injured works can select their own treating doctor, not simply the one to which the employer or the insurance company refer's them, anytime more than 30 days after the date of injury. However, you will need to request your particular insurance carrier's MPN list of physicians from which to choose.
Answer: In most situations, simple written communication and clarification can help get to the bottom of authorization issues. Make sure your primary treating physician has put his request (either for referral or a particular type of service) in writing and that a copy of any such request is sent to the attention of the claims adjuster and/or your attorney.
Once notification to the carrier has been documented, you may have grounds to request a hearing before the Appeals Board, along with a request for a penalty if the delay is unreasonable, but only if all of the above has been satisfied.
Answer: Lump sum settlements in Workers' Compensation, known as a "Compromise and Release" Settlement under California Law, are typically available only where the injured worker gives up his right to life-time medical care. Also, both parties must agree to such a settlement. The Judge cannot order the Insurance Company to pay you a lump sum.