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Medical Treatment Guidelines

The medical treatment utilization schedule is a set of guidelines scientifically recommended to treat a variety of workers’ compensation injuries. It also details how often and how long the treatment should be given. These guidelines are taken from the American College of Occupational and Environmental Medicines’s Practice Guidelines. Our Sacramento Workers’ Compensation Attorneys understand everything you need to know about the medical treatment utilization schedule. They can explain what evidence-based medicine is and the general principles covered in the medical treatment utilization schedule. They can also explain how it affects your workers’ compensation case and treatment.    

What is evidence-based medicine? 

The medical treatment utilization schedule is derived from the principle of evidence-based medicine. Evidence-based medicine is a medical approach that utilizes proven medical evidence to make decisions and recommendations for treating medical conditions or injuries. Generally, any treatment that is listed in the medical treatment utilization schedule will be covered by an employer’s workers’ compensation insurances. 

Your treating physician may be able to provide treatment outside of the medical treatment guidelines. To do so, they must provide other evidence that shows the specific treatment will be effective and is necessary to treat the injury. If the treatment is disputed, it will be reviewed by a third-party through a utilization review process to decide if the treatment will be approved. 

What are the general principles covered in the medical treatment utilization schedule? 

The medical treatment utilization schedule guidelines cover the most common workers’ compensation injuries. They are split into 14 sections and detail how each injury should generally be treated. The most common and important treatments are detailed below. 

Chiropractor  

Chiropractor visits are covered in the California medical treatment utilization schedule as a treatment for workers’ compensation injuries. Chiropractors focus on the musculoskeletal system and manipulate the body to help provide patients with pain relief and increased mobility. 

Visiting a chiropractor to help to treat a work-related injury is common for many injured employees. Many studies have shown that chiropractic care is more cost-effective than other treatments and reduces the potential likelihood of MRI, CT scans, or even surgery. However, an injured worker can only visit a chiropractor 24 times. That means chiropractors cannot be an injured employee’s primary treating physician once the 24-visit cap is reached. However, in some cases, our Sacramento Workers’ Compensation Attorneys can convince adjusters to give employees additional treatment. 

Physical Therapy

Physical therapists work to help patients improve balance, gain greater mobility, and increase their range of motion. However, just as with chiropractic care, there is a 24 visit cap on physical therapy. Many injured employees attend physical therapy for one to two visits to learn exercises that will help stabilize their condition. The amount of visits and for how long, depends on the body part affected and the severity of the condition. 

For example, the MTUS states that one evidence-based treatment for injured employees with cervical and thoracic spine disorders is to attend 12 physical therapy visits for manipulation and mobilization treatment over six to eight weeks. Treatment is assessed every two weeks and can be continued for another two weeks if the patient is responding to the treatment. If no significant response is seen after two weeks, they can switch to a different manipulation and mobilization method for another two weeks. If there is no response to treatment after a total of four weeks, it is unlikely that manipulation and mobilization treatment is a useful way to treat the condition.     

Opioids 

Opioids are detailed in the medical treatment utilization schedule as a treatment for work-related injuries. They do not come without risks, and use should be closely monitored by a physician. Significant caution should be considered when prescribing opioids to patients who have renal or hepatic insufficiency, sleep apnea, psychiatric or mental disorders, or current/past substance abuse problems. Caution should also be taken for patients who are 65 and older or those who may potentially be pregnant. 

Prescribing opioids is not recommended for employees with non-severe acute pain like low back pain, sprains, or minor injuries without signs of tissue damage. However, it can be prescribed, with the close supervision of a doctor to help ease acute severe pain like severe fractures, extensive burns, crush injuries, or injuries with significant tissue damage. Opioids can be prescribed for up to four weeks for post-operative pain, one to three months for subacute pain, or more than three months for chronic pain. The lowest effective dose should always be used and tapering off the medication should be considered as soon as possible.

Home Health Care Services 

Home health care services are recommended in the medical treatment utilization schedule for employees with a work injury following hospitalization or surgery. If the employee is unable to leave their home with assistance or it is not medically advisable to leave the house because of their injury, home health care may be beneficial. The goal of home health care services is to aid in recovery and prevent re-hospitalization.   

What’s next? 

The goal of the medical treatment utilization schedule is to give your medical provider an idea of what treatments will most likely be covered by your workers’ compensation insurance. It is an attempt to reduce conflict during the utilization review process. However, no system is perfect. That is why our Sacramento Workers’ Compensation Attorneys are here to help. They can answer any questions you have regarding the medical treatment utilization schedule. They can explain how it affects your treatment and your workers’ compensation claim. Give us a call today. Our Sacramento Workers’ Compensation Attorneys can answer any of your questions.