Workers' compensation is the nation's oldest social insurance program: It was adopted in most states, including California, during the second decade of the 20th century. The workers' compensation system is based on a trade-off between employers and employees. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries or illnesses no matter who is at fault and, in return, are prevented from suing employers over those injuries.
As a result, California employers are required by law to have workers' compensation insurance, even if they have only one employee. And, if your employees get hurt or sick because of work, you are required to pay for workers' compensation benefits. Workers' comp insurance provides basic benefits, including medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits and a return-to-work supplement, and death benefits.
The vast majority of workers' compensation claims are resolved without any problems. However, sometimes a disagreement can arise between you and your employee over issues such as whether the injury was sustained on the job or how much in benefits they are entitled to receive.
DWC holds the largest workers’ compensation educational conference in the state at sites in Northern and Southern California. Speakers from the division and the private sector will address the most current topics and issues confronting claims administrators, attorneys, medical providers, rehabilitation counselors, and others involved in workers’ compensation.
Medical Treatment Information
Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body regions guidelines adopted from the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain, and therapy after surgery. The Division of Workers' Compensation also has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
Copies of the ACOEM guidelines are available for review at your local DWC district office. Other guidelines not adopted from ACOEM can be reviewed and downloaded from the DWC Web site.
Copies may also be obtained from:
Division of Workers' Compensation
P.O. Box 71010
Oakland, CA 94612-1486
Additionally, you, or the claims administrator representing you, are required to have a program called utilization review (UR), which basically provides a way to double check that the doctor's treatment plan for your employee is sound.
For injuries on or after Jan. 1, 2013, and as of July 1, 2013 for all dates of injury, if UR has delayed, denied or modified a treating physician’s request for a specific course of treatment and the injured employee disagrees with the UR decision, the dispute can only be resolved through a process called independent medical review (IMR).
If your claims administrator has established a medical provider network (MPN) or a health care organization (HCO), your employees' work injuries and illnesses will be treated by a doctor in the network. These networks of doctors are similar to health maintenance organizations (HMOs). If your employees qualified to pre-designate a personal physician and did so prior to being injured they can go to their regular doctor for their workers' compensation care.
Retraining and Return to Work Information
Getting your employees back to work after an injury is one of the most important things you can do for their health and the health of your business. Workers who return to the job as soon as medically possible have the best outcomes: They recover from their injuries faster and suffer less wage loss. You, your employee and your employee's doctor should communicate openly and frequently for the best results.