By Jim Cline and Erica Shelley Nelson
Representing the Injured or Disabled Member
Part 33: Right to Medical Treatment under Workers Compensation
This article is the 33rd in a multiple part series covering the rights your injured and disabled members have and how you, as a union or guild representative, can best assist them. Over the several weeks and continuing for the next several weeks, we’ll be publishing, in various segments, information on how state and federal laws protect your members who are hurt or otherwise unable to work. We’ll cover topics including disability discrimination law, the FMLA, job protection rights under the CBA, workers compensation, disability benefits, and the right to bring a civil lawsuit.
The topics we are covering all also going to be addressed in detail in an upcoming book we’re publishing: HELPING THE INJURED OR DISABLED MEMBER: A GUIDEBOOK FOR THE WASHINGTON LAW ENFORCEMENT AND FIRE UNION REPRESENTATIVE. It is also our intention over the course of the next year to travel through the state and provide training to public safety union and guild representatives on how best to enforce these rights. Expect to hear more on that in the months ahead.
The 33rd article in these newsletter series provides a discussion introducing the topic of the right to medical treatment under workers compensation with several other L&I discussion to follow. For more information, visit our Premium Website. On the website you’ll find an on line version of the Injured or Disabled Member’s Guidebook and other information on the laws covering your members.
Once an industrial injury or occupational disease claim has been allowed, the Department or self-insured employer are legally obligated to pay for “proper and necessary medical and surgical services” provided by a physician or advanced registered nurse practitioner. The injured member is generally permitted to choose his or her own health care providers to treat their medical condition.[1] The workplace injury treatment may include in-patient hospitalization, surgery,, out-patient medical care and rehabilitation, including physical therapy, and prescription medications.
The Department ordinarily recognizes one attending medical provider on a claim. While the worker has a right to choose their own medical provider, the provider must be in the Department’s Medical Provider Network.[2] Even though the Department’s network of providers is fairly expansive, sometimes injured workers have difficulty finding health care providers who are willing to treat them because of the challenges in billing and receiving payment from the Department for covered services. Having a physician to not only treat the injured member, but also to advocate to the Department or self-insured employer on the injured member’s behalf is very important.
In the next article in this series we’ll discuss the right to “time loss” benefits under workers compensation and how lost income is replaced.
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[1] RCW 51.36.010.
[2]Id.
