What’s taking so long for workers’ compensation to approve my care?

On Behalf of | Apr 26, 2022 | Worker's Compensation |

Workplace injuries are an unfortunate reality for many residents of San Diego. As a result, the law in California provides for such circumstances to ensure its residents aren’t crippled by situations beyond their control. Employees are entitled to worker’s compensation if they get injured on the job, and that includes medical care.

Sometimes, however, there can be a lag between what your treating physician wants to be done and the approval from workers’ comp. The seriousness of your injury is what determines how long you will have to wait before treatment is approved. 

Here’s what affects the time that it takes to get approval for some non-emergency care:

Utilization review

This is often used in worker’s comp cases in order to determine whether the treatment prescribed by the physician is medically necessary. However, the claims administrator cannot change the treatment plan or deny you treatment entirely without a physician’s input.

Critical medical care

In the event, your injury poses a significant threat to your life, the claims administrator is required to make a decision within 72 hours and communicate it within 24 hours. 

This is because any delays could affect your full recovery and, therefore, your future job performance.

Non-critical medical care

In this case, the claims administrator has 5 days to approve the treatment plan. However, if they have more questions and require more information, they have 14 days to approve the plan and 24 hours to communicate it.

As an employee, you have every right to seek compensation if you get injured at work. Getting the right representation is important if your workers’ compensation claim isn’t going well or you aren’t getting the treatment you need and deserve.