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Workers’ Comp: Lost Time vs. Medical-Only Claims

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Posted By DAM Firm | May 3 2023 | Workers' Compensation

When individuals sustain workplace injuries in California, they will likely be entitled to workers’ compensation benefits not only for their medical expenses but potentially for wages caused by time away from work. Here, we want to discuss the difference between a claim that involves just medical benefits and claims that involve medical benefits along with lost time.

Lost Time vs. Medical-only Claims

Medical-Only Claims 

Many work injury claims only result in individuals needing medical treatment and no time away from work. Any person who sustains a work injury must seek medical care to receive compensation. If the individual is released back to work after seeking treatment, then this would be referred to as a medical-only claim. 

If a person is allowed to return to modified work duty, this would still only be a medical only claim unless the person must work in a position that pays less than they did before. In that situation, they would be able to receive compensation for the difference between their previous wage and their current wage.

Medical claims should pay for all medical expenses arising as a result of the workplace injury, regardless of whether or not a person is able to return to work right away or not. This includes emergency hospital expenses, ongoing doctor visits, physical therapy and rehabilitation, medical devices, prescription medications, and more.

Lost Time and Recovering Compensation

Lost time claims will always involve compensation for medical assistance, but it will also involve compensation for lost wages. If an injury is so severe that a healthcare provider restricts an employee from their regular duty for a specific amount of time, the injured employee should be able to receive two-thirds of their average weekly wage, calculated from the time frame before the injury occurred. These benefits will typically kick in if workers are either disabled for more than three days due to their injury or hospitalized for an overnight stay.

In the event the injury becomes a permanent disability, there are different systems set up under the California workers’ compensation benefit plans that allow for longer-term benefits.

Contact a Work Injury Lawyer 

If you have any questions about your specific workers’ compensation claim, we encourage you to reach out to a skilled San Bernardino work injury lawyer as soon as possible. Recovering compensation for your work injury must be the priority so you can pay your bills and live life the way you were before the work injury occurred. Regardless of whether or not your injury is only a medical claim or a lost time claim, you deserve the compensation needed to get through this.

Medical-only claims are typically not too challenging when it comes to ensuring prompt and fair payment. Claiming lost time away from work can become more difficult. There are times when employers or the workers’ compensation insurance carriers delay or deny a claim unnecessarily. When you are working with a skilled work injury lawyer, you will have an advocate ready to handle the appeals process on your behalf. This includes fully investigating the work injury, attending any necessary hearings, and securing outside medical experts if needed.