FAQ
If medical care is outside of Contra Costa County Schools Insurance Group’s (CCCSIG) Medical Panel, in certain situations, you have a right to switch doctors. Depending on the type of injury you have, the new treating doctor can be a medical doctor, osteopath, psychologist, acupuncturist, optometrist, dentist, podiatrist or chiropractor.
You or your new treating doctor must give CCCSIG the doctor’s name and address. This allows CCCSIG to obtain medical reports and pay for your medical care.
Your choice of doctor is very important because the treating doctor plays a very important role in your claims case. You should choose a doctor who knows how to treat your type of injury or illness and who understands the workers’ compensation system.
Contact CCCSIG to find out how to change doctors in the first 30 days of your injury.
To change to a different doctor after 30 days after your injury, you must notify CCCSIG of your choice of doctor.
Yes, medical treatment not falling within the American College of Occupational and Environmental Medical Guidelines will be reviewed as provided for by the State Division of Workers’ Compensation.
Be sure to alert your workers’ compensation Doctor that your condition is worsening. The Doctor is responsible for making a medical determination about the worsening of your condition. You may be entitled to receive additional Permanent Disability benefits if your medical condition has worsened and your disability has increased. There is a statute of limitations for this to occur, either five years from the date of your injury or one year from the date of your settlement, whichever is later.
For medical appointments, you must use your sick leave benefits if your appointments are during the work day. Lost time from work due to a workers’ compensation injury is only compensated when a Doctor determines the medical condition is “temporary disabled” and therefore, unable to work. The majority of Doctors, Physical Therapy facilities have extended and weekend work hours to service your treatment needs while working.
In order for CCCSIG to best manage your claim, it is important for us to be able to contact Physicians who may have treated you in the past to assess your medical needs for your workers’ compensation injury, as well as determining appropriate levels of Permanent Disability, should your injury result in same.
To see your own Physician, you must elect to pre-designate him/her prior to a work-related injury. There are specific requirements for an MD, DO or DPM to serve in the role as Treating Physician.
“Future Medical” is awarded if a claim is concluded and benefits for future medical care have been provided for medical-only treatment needs to care for the effects of the workers’ compensation injury, based on the medical treatment guidelines established for workers’ compensation. When a claim is concluded/settled, there generally is a final medical report, which details the future medical needs relating to the claim. These may consist of prescription medications, some specific forms of physical therapy or even surgery.
Your treating doctor may determine that you will never be able to return to the same job that you had before you were injured. The doctor will report this in writing to CCCSIG.
CCCSIG will send you a letter stating that you may be eligible for supplemental job displacement benefits or stating whether your employer is able to offer you alternate employment. If you are offered employment, CCCSIG must also send you an “Offer of Permanent Modified or Alternative Work” on form RU-94, a State pamphlet called “Help in Returning to Work” and a copy of the doctor’s report described above, with instructions on what to do if you disagree with the report.
If your employer offers you work for a date of injury after January 1, 2005, CCCSIG’s notification letter says that your employer is offering you work. The job must meet the work restrictions in the doctor’s report.
A Permanent Modified Job
This is your previous job with changes that meet the doctor’s work restrictions (e.g. changing certain tasks, changing workstation, providing helpful equipment). It must last at least 12 months and pay the same wages and benefits as your old job. You may have only 30 days to accept the offer. If you don’t respond within 30 days, the district could withdraw the offer. (You have more time if the district agrees.) CCCSIG is not required to give you vocational rehabilitation benefits. This is true whether or not you accept the offer.
Alternative Work
This is work that is different from your previous job. It must last at least 12 months, and it must pay at least 85% of the wages and benefits that you were paid at the time of injury. Also, it must be within a reasonable commuting distance of where you lived at the time of the injury.
If your employer doesn’t offer you work for an injury after January 1, 2005, CCCSIG’s notification letter says that your employer is not able to offer you work. The letter must say whether CCCSIG is offering vocational rehabilitation benefits instead. Any remaining Permanent Disability benefits will increase by 15%. If you are offered these benefits, you may have only 90 days to reply in writing that you want them, want an evaluation, or want a delay. If you don’t reply within 90 days, you could lose your right to receive vocational rehabilitation benefits.
The 3-day waiting period has been part of the workers’ compensation regulations for decades. The 3-day waiting period is waived if you are hospitalized overnight, and picked up after 14 days of disability; therefore allowing those more severely disabled to receive this initial lost time benefit.
Any question relating to your “Ed Code” benefits must be addressed with your school district as CCCSIG does not have access to your accrual information, which determines when your benefits will potentially exhaust should you continue to be temporarily disabled from work. All Ed Code Benefits are coordinated by the School Districts.
For regular employees of a school district (non-substitutes), if you qualify for Education Code benefits, you receive 60 days Industrial Accident Leave, which begins immediately, thereby paying full salary from the onset of your temporary disability.
There are five different workers’ compensation benefits; Medical, Temporary Disability, Permanent Disability, Vocational Rehabilitation and Death Benefits – all can begin at different stages of a claim.
The primary benefits received by injured workers are Medical and Temporary Disability.
Medical benefits begin with your first visit with the District Medical Panel Physician or your Pre-designated Physician.
Temporary Disability benefits begin on the 4th day of lost time medically authorized by your workers’ compensation Doctor. There are exceptions to the 3-day waiting period. If you are hospitalized overnight or on the 15th day of Temporary Disability, the waiting period is paid.
When an injury is reported by an Employee to their Supervisor, there are different forms that are provided to assist in reporting a workers’ compensation claim should medical treatment be required. The injured Employee does not have to sign the DWC1 Claim Form, although it must be provided and submitted to CCCSIG so that a claim can be established and an evaluation of benefits may occur.
Utilization Review process and non certification of treatment recommended by the Utilization Review provider shall be resolved through the independent Medical Review process and its policies.
