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Ledgerwood Law Group

Q:
Does California worker’s comp pay for chronic pain treatments?

A:

It should, but in many cases it is difficult to convince California workers’ comp insurers that you are experiencing chronic pain (and then to convince them that they should pay for your treatment).

Chronic pain is generally described as any pain that persists beyond the anticipated time of physical healing. It is the primary reason for recovery delays and increased costs in the workers’ compensation system, as pain can delay a worker’s return to work for months, years, or even indefinitely.

When an injured employee is diagnosed with chronic pain, his doctor should recommend a course of treatment that will manage pain symptoms and increase quality of life. In order for workers’ compensation to pay for the treatment, that recommendation will likely have to be approved by the insurer’s utilization review.

One the plus side, there are medical treatment guidelines specifically addressing treatment for chronic pain. However, treatment for the condition must be outlined in either the chronic pain medical treatment guidelines or clinical topics guidelines for the specific body injured body part in order to be covered by the insurer.

Therapy for chronic pain is usually focused on the restoring maximum function to the injured worker, rather than completely eradicating his pain. Treatments tend to focus on pain management and control, allowing the employee to perceive less pain over time and regain control over his life.

In addition, workers’ compensation may attempt to deny pain treatments once a patient has reached maximal medical improvement. This does not mean the worker is no longer in need of medical care, but since his health is stable, workers' compensation will no longer pay for his suffering.

The Ledgerwood Law Group can tell you how to cope with this denial in our book, The Northern California Workers’ Compensation Survival Manual. Click the link on this page for your FREE copy.