Areas of Practice

Fields of Expertise
  • Workers Compensation
  • On the Job Injury
  • Construction Accidents
  • Personal Injury

Our Location

Visit Us Today
Todd R. Tatro Attorney at Law
6061 North Fresno Street Ste. 108 Fresno, CA 93710


Additional Information:

TOS & Privacy Policy:

Worker’s Compensation Benefits: Medical Treatment

When you’ve suffered an on-the-job injury, your life gets complicated in a hurry. You begin to worry about things you’ve never had to worry about before:

  • Will I lose my job?
  • How am I going to cover my bills if I can’t work?
  • How will I pay for the medical treatment I need to heal my injuries?
  • How long will it take for me to get back to work again?

These are all valid concerns, and create additional stress for you.  Not having the answers to these questions can seem overwhelming and paralyzing. But the answer to these questions can be found very easily by contacting Todd R. Tatro and allowing him to guide you through the entire workers’ compensation claim process.  Although he may not be able to answer all of these questions initially because they differ in every case depending on things such as the nature and extent of your injury and how quickly your body recovers, what he can do is provide you with the needed information to put into perspective the information needed to answer the above questions.

Attorney Tatro has over 30 years of workers’ compensation law experience in helping the Central Valley’s injured workers.  Mr. Tatro is a Certified Specialist in Workers’ Compensation Law, and is clearly the intelligent choice when you’re faced with filing a workers’ comp claim or pursuing a case. Let him help alleviate this burden of trying to handle things on your own by providing the assistance needed in your case so that you the ability to concentrate on healing from your injuries and in getting back to work.

Are You Entitled to Medical Treatment?

You may be wondering if you’re entitled to medical treatment for the injuries or illness you’ve suffered at work. The answer generally is yes; you are absolutely entitled to treatment. Here in California, workers’ compensation laws are meant to protect employees who have been injured or gotten ill due to their job.  However, any treatment is subject to being reasonably required to cure or relieve the effects of your industrial injury.

Having said that, any treatment recommended for your injuries is still subject to whatever laws are in effect at the time it is needed or rendered.  In many situations, without treatment you may not be able to continue doing your job, and if that happens you could be out of a job. When you are out of a job, it affects your ability to take care of yourself and your family or pay for any of your own medical treatments.

Because of the importance of medical treatment when you have been injured on the job, there are effective workers’ compensation laws in place that necessitate that an injured employee receive any and all medical treatments that are reasonably required to cure or relieve the effects of their injuries. But just because you have the right to receive treatment doesn’t mean it’s easy or that you will actually receive all of the treatment needed for your injuries.

There are fairly specific treatment guidelines or protocols for each type of injury suffered, and only an experienced worker’s compensation attorney can help you address the proper medical treatment issues in order to try to assist you in getting the treatment needed, as well as the compensation benefits you deserve for your injuries. Attorney Todd R. Tatro is intimately familiar with on-the-job injuries and the treatment process, and he can work with your medical team or physicians to try and obtain the information needed to increase your chances of receiving the proper treatments needed for your workplace injuries.

Workers’ Compensation Treatment Guidelines

The State of California has guidelines in place for addressing treatments that are considered appropriate for specific injuries.  As long as these guidelines are followed and your physician provides the needed information and support for the recommended treatment along with a Request for Authorization, you have a better chance of getting the needed treatment to help you heal and recover. Occasionally though, a member of your medical team will suggest a treatment for your injuries that isn’t within the guidelines or will suggest a different intensity, duration, or frequency of treatment than what is usually allowed.

In a case such as this, the doctor recommending the treatment will need to provide evidence that the treatment follows other scientifically-based guidelines, and why it is clinically supported in your case based on his or her evaluation. Your claims administrator will probably have the treatment recommended put through Utilization Review (UR) in order to have the treatment recommendations reviewed by another physician.

Based on this UR, they will make a decision as to whether this treatment is warranted in your unique case.  If the treatment is denied, then most of the time you will have to go through the process of appealing the denial through Independent Medical Review (IMR).  Any treatment denial by UR and/or IMR, is usually valid for one year, unless the further recommendation by that physician for the treatment within the year is supported by a documented change in the facts material to the basis of the Utilization Review decision. Under those circumstances it is possible that you might be able to get the previously denied treatment authorized.

Who Pays for Your Medical Treatments?

Every employer in the State of California is required to have Workers’ Compensation coverage.  If they are a governmental entity they could be legally uninsured and provide benefits, or if they are a large employer, they could be permissibly self insured.  For all other employers they are usually insured by paying for a separate workers compensation policy with one of several insurers who offer Workers’ Compensation coverage in California.

The reason for the existence of this type of policy or coverage is in part to pay for any medical treatments that are needed due to a workplace injury or illness. After you’ve filed your workers’ compensation claim with your employer, your claims administrator will directly pay your medical treaters out of the funds that are provided by your employer’s insurance policy for any approved treatment. You should never receive a bill or an invoice for any treatment of an accepted industrial injury that has been authorized and provided within a defendant’s Medical Provider Network (MPN).

As a matter of fact, it is illegal in the state of California for any medical provider to directly bill a patient for a covered workplace-related injury. Essentially, the funds for payment of any authorized treatment go directly from the insurer to your medical providers.

In addition, you may also be eligible to receive limited payments for some medical bills even though your workers’ compensation claim has yet to be accepted. Your claims administrator is required under the provisions of the Labor Code to authorize and pay for any medical treatment costs incurred for your industrial injuries for a total of up to $10,000 within 24 hours of the filing of your claim, and while it is on delay. This can help bridge the gap for immediate treatment, while still providing you protection from having to pay for these medical treatments yourself.

Disagreement Regarding Treatments

In most cases there are issues that arise with needed medical treatment, and often insurers will dispute treatment that they feel doesn’t follow scientifically-based guidelines for that injury that are in place, or if they feel the treatment isn’t reasonable.  A dispute can also arise if the physician does not provide the needed report supporting that the recommended treatment is consistent with the treatment guidelines.  On those occasions, the treatment will be subject to a Utilization Review (UR) process.

Under this process, your physician’s treatment plan will be analyzed by a third party doctor who is hired by your claims administrator. This third party doctor will then make the call on whether they feel the treatment is reasonable, supported by the medical evidence and follows treatment guidelines. If the third party UR doctor deems the treatment reasonable, the insurer must authorize and pay for the treatment.

However, if the third party UR doctor determines that the treatment is not reasonable and/or supported clinically under the treatment guidelines, and denies the treatment, you have the right to appeal the decision. This means the treatment request will go through an additional appeals process that is known as Independent Medical Review (IMR) as long as you properly file all of the necessary documents to start the appeals process and do so within the required strict time limits.

In the case of an Independent Medical Review, a doctor with no ties to you, the insurer, or your claims administrator will review the treatment and give their assessment on whether they feel the treatment is reasonable and necessary to cure or relieve the effects of your industrial injury. If the IMR physician overturns the UR denial, then the insurer must authorize and pay for the previously denied treatment.

All of these various processes and procedures are complicated and can get long and drawn out, all at a time when you want to focus on healing from your injuries and getting back to work. This is why it’s important to trust in an attorney who specializes in workers’ compensation law such as attorney Todd Tatro.  Mr. Tatro is a lawyer who can ultimately help you resolve your claim for the most beneficial outcome. Contact his office today at (559) 431-0123 or use his online contact form.