Workers' compensation provides medical expenses, lost wages, and rehabilitation costs to employees who are injured or become ill “in the course and scope” of their job.
Following an on-the-job injury or work-related illness, there’s a limited amount of time to report the injury and file a claim. Therefore it is important for caregivers to report it to their HR Specialist immediately. These requirements apply no matter how slight or minor the injury might seem. If you have questions about whether the injury is reportable, still call your HR Specialist and ask – do not make these decisions on your own. You will then be asked to sign authorization forms which will allow us to start the process of reporting it to the workers comp insurance company.
Once reported, In order to ensure that your medical treatment will be paid for by CareSphere you must select from one of the following health care providers:
- You must continue to visit one of the physicians listed below, if you need treatment, for ninety (90) days from the date of your first visit. If one of the persons below refers you to another licensed specialist, your employer or their insurer will pay the bill for these services.
- After this 90 day period, if you still need treatment and CareSphere has provided a list as set forth below, you may choose to go to another health care provider for treatment. You should notify CareSphere of this action within five days of your visit to said provider.
- if a physician on this list prescribes invasive surgery, you may obtain a second opinion from any physician of your choice, if the second opinion is different than the listed physician's opinion, you may determine which course of treatment to follow; however, the second opinion must contain a specific and detailed treatment plan. If you choose the second opinion, the procedures in that opinion must be performed by one of the physicians on the list for the first 90 days. Therefore, in this situation, the employee may be required to treat with an employer-designated provider for up to 180 days.
- If you are faced with a medical emergency, you may secure assistance from a hospital, physical, or health care provider of your choice for your work related injury. However, when the emergency is resolved, you must seek treatment from a provider listed above
Your failure to follow this procedure may result in the appropriate workers’ compensation report not being filed in accordance with the law, which may consequently jeopardize your right to benefits.