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CSC: out-of-network records a-okay in workers' comp case

After a serious injury, whether we can get healthy and return to work truly can depend on the medical treatment that we receive. Health care is very personal, which is why a successful treatment plan can not only depend on the advanced medical treatment options but on our comfort with treatment staff as well.

Sometimes, in order to get this level of care, we have to step outside of our employer’s provider network. Could that decision affect a workers’ compensation claim? An employer recently argued that in California, medical records from an out-of-network facility would not be admissible as evidence in a workers’ compensation case. Not so fast, said the workers’ comp judge, and the California Supreme Court recently agreed.

This case started, as all do, at the trial level where the original argument was made. The workers’ compensation judge said the argument didn’t hold water. “Records from treating doctors have always been admissible,” he wrote in the opinion, whether they were in network or out didn’t make a difference.

That ruling was appealed and overturned by an en banc panel of the California workers comp appeals board. Then, when appealed again, the ruling was again overturned, this time by the California Court of Appeal. If you’ve lost track, we’re in favor of the injured worker again. Of course, this appeal ruling was once again disputed.

The case has finally come to rest in the highest court in the state, confirming the decision from the California Court of Appeal and the original ruling. The California Supreme Court ruled that the employer was trying to impose a requirement that an injured worker must seek care in a provider network in order to receive workers’ comp benefits. “The legislature has imposed no such requirement,” wrote the court.

The truth is that when individuals injured in a workplace accident are forced to battle their employer or an insurance company for benefits, it isn’t an easy fight to win their own. This is where a Santa Ana workers’ compensation attorney steps in to help.

Source: Business Insurance, “Out-of-network medical records OK as evidence in Calif. Work comp cases,” Sheena Harrison, Nov. 15, 2013

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