1. Definition of notice – An employee is required to notify his employer of two items: first, that he suffered an injury and second that the injury was related to his work. Both of these facts must be given before notice is adequate. Most commonly, an employee fills out an accident form provided by the employer. These forms are fine, but they are not required. It is sufficient for you to tell your supervisor verbally or write a letter, as long as you make clear that the injury was caused by your work. The notice requirement can also be satisfied if the employer witnesses the injury, has actual notice of the work injury through its receipt of doctor’s records or being informed by a co-worker, as long as the employer is aware of the relationship between the injury and the work activities.

2. Time limitations for giving notice – The 120 day period for giving notice starts to run when the employee knows or should know that the injury occurred and its possible relationship to this employment. Thus, if an employee develops a condition which he suspects is related to his work activities, he should notify his employer and obtain medical advice right away. If the notice requirement is not met, the claim is barred completely and no benefits are payable.

There is some flexibility of the notice requirement in cases where the employee has a “continuing multiple trauma,” such as repetitive motions which aggravate carpal tunnel syndrome. In these cases, the injury is not considered to have occurred until the last date of exposure to the work activity, which is usually the last day of work. The notice time in this situation does not begin to run until the last day of work.

3. Importance of promptly giving notice – While the Act states that the employee has 120 days to give notice of the injury, the Act also provides that compensation benefits may not have to be paid for every date of disability before notice is given, if the notice is given after 21 days but before the 120 day period. This means that if notice is given after 21 days, the claim may eventually be accepted, but no benefits may owed before the time that the employee gave notice. It is thus in your interest to give complete notice to your employer as soon as you suspect there is a work-related condition.

There is an exception to this requirement if your accident is an emergency situation which requires immediate treatment. In this case, you should go to the closest hospital without worrying about whether it is on the panel. In an emergency, the visit should be paid even if the treating facility was not a member of the panel.

2. Choosing your own provider – If your employer does not give you written notice (usually by posting it at work) that treatment with a panel physician is required, you may choose your own provider for treatment. However, the treating physician is required to notify the employer of his treatment within five days after treatment has begun. You may want to remind your medical provider of this requirement at the time of your first appointment.

Once an employee has a work injury, the employer is responsible for payment of all “reasonable and necessary” medical expenses causally related to the injury. This responsibility continues unless the employer can show that the employee does not need further treatment for his injury.

The employer’s duty to pay medical bills is often a source of dispute once the claim has been accepted. It is common for employers to decide that an employee is seeing a chiropractor too often or should not be receiving physical therapy. The burden is always on the employer to show that your medical treatment is not reasonable and necessary and if the employer wishes to raise this, it is done by the filing of a “Utilization Review Request” or “UR.” Please note that the employer can always refuse payment of a bill if it believes the treatment is “not causally related” to the accepted work injury. If the employer fails to pay for this reason, the employee must file a petition and convince the worker’s compensation judge of the casual relationship.

If your employer files a UR, you will receive notice of this in the mail. The UR form will state which medical treatment is being disputed and the dates of treatment. It is important to know that the employer is not responsible for payment of medical treatment if it files the UR request within 30 days of the date it received notice of the treatment. The medical provider cannot seek payment from you during the time when the UR is being considered, but it may affect the provider’s willingness to continue treating you.

Within a few weeks after receiving the UR notice, you will receive a Notice of Assignment, which lists a medical organization which will review your medical records. You then have 20 days to submit a written statement which states why the treatment is beneficial. You are strongly encouraged to do this, as it may have a positive impact on the decision. (The address where the written statement should be sent is listed on the form.) Within a few weeks, you will receive a written decision which states whether the treatment has been approved. If the treatment is denied, the appeal procedures are stated on the form. These procedures involve filing a petition with a Worker’s Compensation Judge, and it is recommended that you seek legal advice if you wish to pursue an appeal.

A final note on medical payment concerns the issue of whether the employee has reached “maximum medical improvement” of her work-related condition. When the injury is no longer recent and the employee has been treating for a while, the employer may feel that the employee is now receiving “maintenance” type care that will not result in any lasting improvement in the condition. An employer will sometimes file a UR for this reason. Such treatment is likely to be approved, as recent decisions by judges have found that as long as medical treatment is designed to keep an employee’s pain under control and allow him to engage in daily activities, such treatment is reasonable and necessary. For more information on the subject of “maximum medical improvement”, please see the Length of Time for Benefits discussion later in this section.

2. Payment of wage loss benefits – An employee is entitled to cash benefits (usually paid at the same rate the employee receives her paycheck), if her work injury causes her to be disabled from work. As with medical bills, there can be much dispute in this area.