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Rock Street, San Francisco

Workers Compensation is a really intricate system, A disputed issue arising under the claim regarding compensability or eligibility for, or the amount of, income or death benefits law companies can stand toe to toe for your rights.

Medical Fee Disputes; Medical Fee Disputes involve a dispute over the amount of payment for health care rendered to an injured worker and determined to be medically necessary and appropriate for treatment of the worker’s compensable injury. The dispute is for reasons aside from the medical necessity of the care. The dispute is resolved by the commission pursuant to commission rules, relating to Medical Dispute Resolution of a Medical Fee Dispute.

Employee Reimbursement Dispute. An employee who has paid for health care may request medical dispute resolution of a denied reimbursement. The worker may only pursue reimbursement up to the amount the employee paid the supplier. Reimbursement shall be just and reasonable in accordance with commission rules, and will not exceed the Maximum Allowable Reimbursement as shown at the suitable fee principle, or in the absence of a fee guideline, the amount determined to be just and reasonable for the healthcare.

An injured worker may choose to be given a brand name drug as opposed to a generic drug or over-the-counter alternative to a prescription drug that’s prescribed by a medical care provider. In such cases, the injured employee will pay the difference in price between generic drugs and brand name drugs. The transaction between the worker and the pharmacist is deemed final and isn’t subject to medical dispute resolution by the Commission. Furthermore, the employee isn’t entitled to reimbursement from the insurance carrier for the difference in cost between generic and brand name medications.

Post Author: Adam Eaglin