Are There Limits to the Medical Treatments You Can Get in Workers’ Comp?

Doctor holding cellphone

Workers’ compensation is designed to help you recover from a workplace accident and get back on your feet as soon as possible. One of the most important ways it assures that you can recuperate is that it pays for your medical treatments. Is there a cap to how much medical treatment coverage you can be provided through workers’ compensation, though? Will your benefits eventually run out and you have to start paying for medical care out of your own pocket?

No, there is no cap on workers’ compensation medical benefits in California or any other state. As long as you are receiving necessary medical care in relation to an injury or illness that you suffered at work, you should have effectively unlimited coverage.

Coverage for Miscellaneous Medical Costs

The prices of medical treatments and hospitalization are only part of what is covered under the “unlimited” amount provided through workers’ comp. Any miscellaneous medical cost related to your treatments should also be fully covered, meaning that you should never have to pay a cent for your care.

Miscellaneous medical costs covered in workers’ comp include:

  • Copays: Many healthcare insurance plans include copays for checkups and treatments. Paying $20 or so each time you have to go to the doctor can add up. With workers’ compensation coverage, your copay amounts should be handled by the insurer.
  • Deductibles: A deductible is an amount that must be paid by a policyholder for treatments before the insurance company steps in and handles the rest. Healthcare insurance usually includes a deductible of $1,000 or more. Deductibles for treatments related to your work injury should also be covered.
  • Prescriptions: Pharmaceutical medicines like painkillers and antibiotics are commonly prescribed in many aftercare regimens. You should not have to pay for your initial prescriptions or refills, even months or years in the future if the prescription was first written due to a workplace injury.
  • Travel costs: You might even be eligible to receive reimbursement for travel costs incurred because you had to go to the doctor for a checkup after a workplace accident. For example, you can be reimbursed for the price of fuel, ridesharing services, or public transportation.

Only Necessary Treatments are Covered

Keep in mind that only your necessary medical treatments are covered by workers’ compensation benefits. A medical provider has to deem a treatment as required for you to reach maximum medical improvement (MMI). If it is not, then the insurance company can refute the coverage and say that it was an elective treatment. You can be required to pay for elective treatments out of your own finances unless you can prove that the treatment should be counted as one that is necessary.

Not sure if your medical treatments are being properly covered by workers’ compensation? If you live in Santa Clarita or Glendale, California, then you can call (818) 946-0608 to connect with the Law Offices of Wax & Wax. Our workers’ comp lawyers can help you make sense of your case or claim.