Most businesses with employees in California are required to participate in the workers’ compensation program. Employers carry coverage that pays for disability benefits and medical treatment if workers develop health challenge. Those benefits reduce the risk that workers assume when taking new jobs and also the financial strain on a business when workers have medical challenges. Companies also have reduced risk of worker lawsuits when they comply with coverage rules.
The medical coverage available through workers’ compensation is particularly useful, as it pays for all of someone’s treatment costs. Workers don’t need to meet a deductible or cover any co-pays. When do medical benefits typically end for those with job-related health challenges?
After the worker fully recovers
The best outcome in a workers’ compensation claim is when an employee makes a full recovery. Someone with a broken bone or other injury can reach a point where they no longer have any noticeable symptoms. At that point, medical coverage ends and they need to return to work.
After a worker stops responding to treatment
Some medical conditions are unlikely to lead to a full recovery. Someone with a repetitive stress injury, for example, is forever at risk of their symptoms resurfacing after undergoing treatment. Doctors sometimes determine that a patient has achieved maximum medical improvement (MMI), which is a way of saying that additional treatment is unlikely to improve their condition. Benefits do not fully end when someone achieves MMI. Instead, the worker may no longer qualify for treatment benefits but only symptom management benefits.
After the worker becomes ineligible
Sometimes, workers lose their medical benefits not due to a full recovery or achieving MMI but instead due to mistakes that they make. A failure to comply with medical instructions could be sufficient reason to eliminate someone’s workers’ compensation benefits. Employees receiving benefits need to make sure they follow all necessary rules to avoid the premature termination of their benefits
Occasionally, when workers question the determinations made by physicians, they may need help appealing or obtaining a second opinion. It can be difficult for employees to assert themselves during a workers’ compensation claim. Learning about the rules that govern California workers’ compensation benefits, and seeking personalized guidance whenever necessary, can help people secure the support they need.
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