In California, physicians are required to report on a number of items when handling a workers’ compensation case. For an injured worker, understanding these terms is crucial since they can mean the difference between the payment or non-payment of benefits and can determine if a worker can return to work or not. According to the Labor Code and Regulations, the physician’s opinion on these items is considered “medical determinations.”

Defining Medical Determinations

In this context, a medical determination is defined as a decision that is made by the injured worker’s primary treating physician for any medical issues that are necessary to determine the employee’s eligibility for compensation. Some of the issues included in a physician’s medical determination include the continuing medical treatment of the injured worker, the decision to release the injured worker from care, and the point at which the injured worker reached permanent and stationary status.

• To be “released from care”, according to a physician’s medical determination, means that the injured worker’s condition reached a permanent and stationary status and there is no need for further medical treatment. Being released from care would also put an end to workers’ compensation benefits.

• “Continuing medical treatment” refers to the treatment that an injured worker is currently receiving or planned treatment that is reasonably required and seeks to relieve or cure the injured worker of the negative effects of the work-related injury.

• When an injured worker’s physician indicates that “future medical treatment” is necessary, this generally makes it far more likely for an injured worker to be eligible for an award of future medical care.

• “Permanent and stationary status” in a workers’ compensation case refers to the point at which an employee reaches maximum medical improvement and his or her condition has stabilized. A worker who has reached this point would likely cease to receive workers’ compensation benefits and would be able to return to work, assuming the worker’s maximum medical improvement was one that allowed for a full recovery.

Can an Injured Worker Contest Medical Determinations?

In California, workers’ compensation law provides injured workers many avenues for contesting a medical determination from a physician, including sending an interrogatory to the physician, deposing the physician, obtaining another physician’s opinion, and obtaining an agreed medical evaluation or qualified medical evaluation. Whichever option you choose, you should consider hiring a skilled workers’ compensation attorney to handle your case to avoid any unnecessary or costly mistakes.

Experienced Workers’ Compensation Attorneys in Orange County

At Alvandi Law Group, P.C., our team of Orange County worker’s compensation attorneys are dedicated to assisting injured workers throughout the claims process. If you were injured at your place of work, you will need skilled legal representation on your side to ensure every step goes smoothly. Backed by a proven track record of success, you can rest assured that your workers’ compensation claim is in good hands with us.

Get started on your case today and reach out to our law firm at (800) 980-6905 to request a free initial case evaluation. We will only accept payment after we win your case.