Medical Benefits

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Medical Benefits	en español

Medical benefits.
	If you are injured at work and need treatment, go to the emergency room or doctor of your choice and say you were injured at work. The doctor will file the workers' compensation claim for you. If your claim is approved, L&I or your self-insured employer will cover medical bills directly related to your injury. This coverage may continue until your doctor certifies your injury has stabilized and reached a point where further recovery is not expected.
Questions workers have: Will my medical benefits continue if I go back to work? Yes. If your claim is still open, you receive medical benefits even if you are working. What medical care is not covered by workers' compensation? Workers compensation cannot pay for: Medical conditions not related to your workplace injury. Treatments with benefits that cannot be measured objectively by a doctor or that continue after the worker is medically stable. Treatments not covered by workers comp, such as acupuncture. Why does my Notice of Decision say that my claim is both allowed and closed? Many injuries are treated and healed before the paperwork reaches L&I. In these cases, we may issue a single decision both authorizing medical expenses and legally closing the claim. This saves time and paperwork for everyone. What if I thought I was okay, but now I need reopen my claim for more medical care? If your claim was closed, you and your doctor may protest with in 60 days. Later than that, you and your doctor may apply to have it reopened so that your medical bills can be paid, as long it is for the same workplace injury. Also, your doctor may refer you to a specialist (such as a surgeon or an orthopedic specialist). What is vocational (return‑to‑work) assistance? Depending on your injury, you may have difficulty returning to work right away. Your claim manager may assign you to a vocational counselor to help develop a solution involving you, your employer and your doctor. Read more about Vocational Services. What if I live or move out of state? Your rights, benefits and responsibilities for your claim will remain the same. Washington laws will always apply to your claim regardless of where you live. Many doctors and providers don't accept workers' compensation cases. Find a Doctor in your area. Thinking of Moving Out of Washington? (28 KB PDF). Get Help Downloading Files (files open in a new window). What if I need to change doctors? You may change doctors as long as the new doctor is qualified to treat your accepted injury or illness. Your request to tranfer to a new doctor is subject to approval by your claim manager. You must notify us in writing of your new doctors name, address and phone number. Many doctors and providers don't accept workers' compensation cases. Find a Doctor in your area. What if I need help finding a new doctor out of state? Use the L&I search at Find A Doctor. If you are unable to find a provider, talk to your claim manager. The claim manager may assign a Nurse Case Manager (NCM) to help you find a doctor. Nurse Case Managers (NCM) are privately employed individuals in your geographic area who receive referrals from L&I. The NCM does not direct you to specific providers but will help you find needed health care resources. The NCM helps your health care provider understand what is needed by L&I.
Did you know? You may change your doctor once your claim is accepted. Send your claim manager his/her full name, name of clinic or hospital, address and phone number. Or, you can fill out a change of Attending Physician form (F245‑037‑000).

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