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Why medical information is important in work comp cases

Proper medical treatment is a cornerstone of the proper administration of California’s workers’ compensation system. Essentially, treating doctors must implement treatments that are scientifically proven to abate the injuries or illnesses that a worker suffers from as a result of an on-the-job injury or accident.

To that end, physicians must follow a set of guidelines approved by the workers’ compensation board regarding which treatments are appropriate for particular injuries, their frequency, and how long they should be given. In following these guidelines, the State of California has developed a medical treatment utilization schedule (MTUS) that applies to different body regions as treatment is contemplated. 

Essentially, the MTUS incorporates the guidelines adopted by the American College of Occupational and Environmental Medicine and provides for protocols that guide treatment of chronic pain and therapy after surgery.

At the same time, employers are required to verify that the treating physician’s treatment program is medically sound and appropriate for the particular injury to be rehabilitated. This verification called a utilization review (UR) and must be completed within strict timelines. Indeed, the UR is a way for the employer to work in concert with the treating physician, but disputes raised in a UR could lead to compliance issues down the road.

As such having an experienced workers’ compensation defense attorney involved to monitor the progress of MTUS and URs can help in avoiding additional litigation costs and fines in the future. If you have questions about the medical treatment information that is required by the state, contact an attorney. 

Source: State of California – Department of Industrial Relations, Division of Workers’ Compensation

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