The law requires the employer to authorize medical treatment as required and limited by the law within one day after an employee files a claim form. Treatment is authorized until the claim is accepted or rejected, up to a limit of $10,000 in total. All medical treatment is provided in accordance with the medical treatment utilization schedule.
If State Fund accepts your claim, we will pay all approved medical care that is reasonable, necessary, and supported by evidence-based treatment guidelines. This care may include doctors, hospital services, physical therapy, lab tests, x-rays, and medicines. Related reasonable transportation expenses are also provided. For injuries on or after January 1, 2004, there are limits on the number of chiropractic, occupational therapy, and physical therapy visits.
As of January 1, 2004, State Fund is required to review medical treatment requests from your physician through a Utilization Review (UR) process. Doctors and other health consultants review your treatment needs based on the medical information provided by your physician to State Fund. There are time limits to approve, modify, delay, or deny treatment requests from your physician.
State Fund pays for all authorized treatment. You should not receive any bills. You are not responsible for co-payments or balance-due bills after we have paid the provider. Contact your claims representative right away if you receive any bills, or if a medical provider or pharmacy demands payment up-front.
Call 911 if you have a medical emergency or go to an emergency room right away. Your employer may advise you where to go for treatment. Tell the healthcare provider who treats you that your injury or illness is job-related. If possible, give your employer's workers' compensation carrier information.
The information provided is not intended to supersede or be used in lieu of the “notice of benefits” handout that employers are required to provide to workers. For State Fund policyholders, this notice is in the New Employee's Guide to Workers' Compensation (English/Spanish) - e13286 [448 k].