Does workers’ comp cover future care?

A serious work injury can have effects that last a lifetime. You may heal from the initial accident, but what about the doctor’s visits, physical therapy or medication you might need years from now?  

This is “future medical care,” and it is a critical part of a workers’ compensation claim. Many injured workers worry about how these long-term needs will be covered after their case is “closed.” 

How future care is included in a settlement 

In California, there are two primary ways to resolve a workers’ comp case. The path you choose directly impacts your future medical care: 

• Stipulation with request for award: This type of settlement leaves your right to future medical care open for the specified injury, often for life. The insurance company agrees to pay for all reasonable and necessary treatments. 

• Compromise and release (C&R): This is a lump-sum settlement that fully closes your entire claim. To get this lump sum, you agree to give up your right to future care through the workers’ comp system. The settlement amount must account for the estimated cost of this future care. 

This decision is critical, as the right choice often depends on the specific, long-term care your doctor anticipates. 

What is a future medical care report? 

You cannot simply state that you will need care in the future. Your need must be documented by a physician. This is often done by a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME). 

This doctor will write a detailed report that outlines what treatments you will likely need, from physical therapy to prescription refills. This report becomes the basis for negotiating the value of your future care. Without this medical evidence, it is very difficult to get the insurance company to agree to pay for it. 

Why this choice is so important 

Deciding between an open medical award or a lump-sum buyout is a complex decision that impacts your long-term health and financial stability. That is why understanding your medical-legal report is a critical step.  

If you are unsure about how to proceed, consider speaking with an experienced attorney. They can review your situation and help you weigh the options against your long-term medical needs.