Future medical treatment is a separate workers’ compensation benefit and can be an important settlement consideration. California law requires the employer to provide treatment reasonably required to cure or relieve the effects of an industrial injury, subject to the applicable treatment-review process. This is typically a lifetime benefit and obligation that is handled by the insurance company.
What counts as future medical treatment?
Depending on the accepted injury and medical evidence, future care can include medical or surgical treatment, medicines, equipment, nursing, chiropractic care, acupuncture, and other reasonably required treatment.
MTUS, utilization review, and IMR
Treatment requests are evaluated under California’s Medical Treatment Utilization Schedule (MTUS) and utilization review process. When applicable, disputes over utilization review decisions proceed through independent medical review (IMR). A doctor’s recommendation therefore does not automatically guarantee authorization or performance of a treatment.
Future medical under different settlement structures
Under Stipulations With Request for Award, approved future medical treatment commonly remains open for the accepted industrial injury. Under a Compromise and Release, future medical liability is usually resolved as part of the approved lump-sum agreement, subject to the actual written terms.
Why future medical value is not simply the retail cost of care
A projected course of treatment is not necessarily paid dollar-for-dollar in settlement. Medical necessity, frequency, duration, industrial causation, utilization review, uncertainty, and negotiated risk can all matter. Costs are also based on Medicare Fee schedule and not what a private doctor may charge.