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What should I know about workers’ compensation medical benefits?

On Behalf of | Apr 8, 2022 | Workers' Compensation

Workers in Providence, Bristol County and throughout Rhode Island are always at risk of suffering some sort of work-related injury. This is true regardless of the kind of work they do. For people who are in physically hard jobs like construction and manual labor, the dangers are inherent. First responders have a responsibility to run toward situations that place them in harm’s way. Still, anyone can be hurt at work. That includes office workers who do not expect to be involved in a work-related accident. Workers’ compensation benefits are in place to help those who might have been hurt. The fear and concern over how to make ends meet and get medical care is real and those who are confronted by this challenge should know how the treatment is paid for.

The importance of medical benefits

Work injuries come in many forms and can have a various impact on a person physically, emotionally and financially. They can be injured lifting, from a fall, by being burned or hit by an object. There are seemingly endless ways to be hurt on the job. Some injuries are not as obvious as others. This is frequently the case with back injuries and other soft tissue damage. Getting the proper medical care for the necessary duration can mean the difference between making a full recovery or being compromised for an extended period if not forever. The person might not be able to do the same type of work as before and wonder how they will move forward. Under the state rules for workers’ compensation, there are basics about medical care that should be known.

After the injury, the worker can select their first medical provider. If, for example, the person was injured in a fall and needed immediate care at an emergency room, that does not count as a first medical visit. If a workplace doctor provides care, that does not count as a first medical visit either. After completing the first covered visit with a general practitioner or a specialist, the worker can choose to select a different doctor. That will need approval by the insurer or an employer that is self-insured. The employer will pay the medical bills with no cost to the worker.

The limit as to how much medical care is provided will be based on the workers’ maximum medical improvement (MMI). Once the worker has achieved MMI, any treatment for the aftermath of the injury will stop at 12 visits or 60 days. For more care to treat pain and other problems, the insurer must give approval. If a worker needs rehabilitation, that is provided at a specific location and will help them physically, vocationally and psychologically. People who are getting incapacity benefits for 26 weeks will need to take part in an independent examination. This will determine the person’s progress and play a substantial role in whether benefits will continue.

Medical benefits should be fully understood from the start

Not knowing how long paychecks to cover lost time will be coming into a household is worrisome; not knowing if the medical care will be sufficient to treat the injured person is also a concern that is often understated. If there is a discrepancy between what the worker believes is needed in terms of medical care, rehabilitation and other treatment vs. what the insurer says, this could be a major obstacle. Having guidance to navigate the legal system and maximize workers’ compensation benefits is crucial. This should be known and action taken from the outset to avoid disputes and get what the worker is entitled to under the law.