MEDICAL EXPENSES (PART 1)
Just what types of benefits are available to injured employees under the Virginia Workers’ Compensation Act (the Act)? As one of the Deputy Commissioners attempted to explain to a client of mine, you need to think of the typically awarded benefits like they were 2 pots of money. One pot is payment of medical benefits, and the other is what attorneys call indemnity damages for lost wages. There are other types of benefits available to an injured employee in a comp claim, such as awards for permanent partial disability (PPD) or for permanent total disability (PTD), but those awards are not made as often. Let’s take a look at medical benefits in this post and the one following this one, and save indemnity for another time.
Medical benefits are set out in VA Code section 65.2-603(A)(1). “As long as necessary after an accident, the employer shall furnish free of charge to the injured employee a physician chosen by the injured employee from a panel of three physicians selected by the employer, and such other necessary medical attention.” The medical benefits, which the employee is entitled to receive and the employer is required to furnish, are incidental to, and a part of, the compensation to which the employee is entitled under the Act. The employer is liable only for medical and hospital charges when the employee is entitled to compensation.
1 Va. App. 195, 199 -200,336 S.E.2d 903, 906 (1985).
Like most medical issues before the Commission, causation is ordinarily shown through medical evidence.
26 Va. App. 66, 74, 492 S.E.2d 858, 861-62 (1997).
Since the employer is required by statute to provide medical care ‘free of charge,” the employer is responsible for reasonable and necessary transportation costs in connection with the medical treatment. Where claimant drives his/her own vehicle, claimant is entitled to reimbursement based on mileage, and the Commission periodically establishes the applicable rate per mile. Many of our clients profess ignorance about this reimbursement, and employers generally pay it only when asked and when claimants have documentation. The same mileage allowances apply to trips to and from vocational training courses, but different rules apply to picking up prescription medications from the pharmacy. Whenever possible, the Commission expects claimants to pick up their medications when the would otherwise have errands to run or need to make other trips to the vicinity of the pharmacy to eliminate separate trips for the sole purpose of getting medication.
Where the work accident aggravates a pre-existing condition, “disability resulting therefrom is compensable under the …Act.”
3 Va. App. 408, 414, 350 S.E.2d 225, 228 (1967).
While the employer may exercise some control over the medical costs incurred by claimant, e.g., initial selection of physicians on the panel submitted to claimant, the employer may not engage in “medical management.” The Commission is clear that employers cannot limit the ATP’s medical management of a case or dictate the referral of a claimant to a particular specialist or facility by its approval or disapproval of the medical bills.
VWC File No. 127-28-93 (Feb. 8, 1990).
In my next post, I will discuss 2 instances where the employer must pay for medical procedures which are not intended to cure the employee.