Worker's Compensation Insurance

4 Medical Care Injured workers are entitled to receive all medical treatment reasonably required to cure or relieve the effects of a work- related injury or illness. Medical care can include physician services, hospitalization, physical restoration, physical therapy, chiropractic treatment, dental care, prescriptions, x-rays, laboratory services, or any other care considered necessary and reasonable by the treating physician, subject to applicable treatment guidelines. Other than certain treatment requests made by treating physicians in an employer’s Medical Provider Network (MPN), all requests for medical treatment are sent by the treating physician to the workers’ compensation insurer for utilization review (UR). Treatment requests will be either allowed, modified, or denied. An injured worker may challenge a decision to modify or deny treatment by requesting an independent medical review (IMR). For more information on UR and IMR, contact the Division of Workers’ Compensation’s (DWC) Medical Unit, which is a division of the Department of Industrial Relations (DIR), using the information shown in the “Resources” section. Generally, the employer is responsible for arranging medical treatment for the first 30 days from the date the injury or illness is reported. However, an employee may obtain treatment from his/her personal physician if the physician is predesignated, prior to the work-related injury or illness, which means the employee must notify his/her employer that he/she opts to obtain treatment from his/her personal physician in the event of a workers’ compensation injury or illness. In most cases, if the employee did not predesignate and the employer or its workers’ compensation insurer opted for a Health Care Organization (HCO) or an (MPN), the injured employee will first be treated in the HCO or MPN. An injured employee’s ability to switch treating physicians will depend on whether he/she is being treated in an HCO, MPN, or by his/her predesignated physician. For further information, employees may contact the Information and Assistance Officer at their local DWC office using the information shown in the “Resources” section.