Medical benefits
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Choosing a physician
Your employer may have a company physician who has been designated to treat any work-related injuries. If your employer does
not have a company physician, you may choose your own physician.
Changing your physician
You must receive a referral from your treating physician if you wish to change physicians. If you are unable to obtain a referral
from your physician, you can contact the State Insurance Fund and request a change in physicians. If the Fund will not authorize a change
of physician, you can petition the Industrial Commission for a change of physician.
Independent medical evaluation
There may be a point in your claim when your claims examiner requests you be seen by a physician or panel of physicians. The reasons
will vary depending on your claim. The physicians chosen will be specialists for your type of injury or illness. You will be given
adequate notice of the appointment, and necessary travel expenses will be covered.
Reporting
In order to receive payment, the physician or hospital must provide the State Insurance Fund with a medical report and billing. If
a report is not received, there may be a delay in payment of your bills. You should notify your physician of the claim number you have
been assigned to ensure any information he or she sends the State Insurance Fund can be routed to your claim file.
Payments
Medical charges are paid based on usual and customary rates. If a bill paid on your file is reduced to comply with usual and
customary rates, you are not responsible for the balance of the charges. If you should receive any statements requesting you to pay any
balance of charges, you should contact the State Insurance Fund. You will be responsible, however, for charges unrelated to your injury or
non-covered expenses incurred.
Covered items
Reasonable and necessary medical treatment as prescribed by your treating physician is provided. The following benefits are
covered:
- All medical, surgical, hospital and nursing care reasonably necessary for treatment and rehabilitation, including prescribed
medications.
- Crutches and apparatus prescribed by the attending physician that may be needed for a reasonable time.
- Necessary replacement or repair of appliances or prosthesis unless the need is due to a lack of proper care by the injured worker.
- Reimbursement for reasonable travel expenses for medical examination or treatment.
- Replacement of glasses with like kind and quality when broken in a work-related accident when injury has been sustained. It is
not necessary that the injury require medical attention by a physician. Injuries such as abrasions, bruises, etc., may be sufficient to allow
for replacement of broken glasses.
Diagnostic testing
In non-emergency cases, the State Insurance Fund requests providers notify the Fund prior to proceeding with testing such as MRI,
CT scan, nerve conduction studies (NVC/EMG), myelograms and discograms. The injured worker should ask their physician to
contact the State Insurance Fund if the physician recommends the injured worker undergo diagnostic testing.
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