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Workers’ compensation can be complicated. We understand this, and encourage you to contact us with any questions or concerns.
Above the MPA retained limit of $1 Million per occurrence, CARMA (the excess pool) covers another $3 Million per occurrence, then purchases commercial excess coverage of another $25 Million, for a total limit of $29 Million for covered claims.
Member's deductible plus MPA limit of liability = $1,000,000Excess pool limit of liability = $28,000,000TOTAL limit of liability = $29,000,000
If the employee has properly completed and submitted a pre-designated personal physician” to treat in the event of a work-related injury, the employee may go to that physician for initial treatment. A pre-designation form must be on file prior to the injury.
All treatment is subject to a process known as Utilization Review (UR). Utilization review is the process used by employers or claims administrators to review medical treatment recommendation to determine if it is medically necessary. All employers or their workers' compensation claims administrators are required by law to have a UR program. This program is used to decide whether or not to approve medical treatment recommended by a physician, which must be based on the medical treatment guidelines. Treatment is certified, partially certified or non-certified, based on whether the treatment is considered appropriate according to evidence-based medical guidelines. MPA will only pay for certified or authorized treatment, rendered by the treating physician or authorized consulting providers.
There are no deductibles or co-payments. Charges are paid in accordance with official fee schedules or negotiated PPO contracts. Medical Treatment Guidelines
Those benefits include, but are not limited to:
A presumption that your injury or illness was caused by work if your claim is not accepted or denied within 90 days of giving the completed claim form to your employer.
Up to $10,000 in treatment under medical treatment guidelines while the claims administrator considers your claim.
An increase in your disability payments if they're late.
A way to resolve any disagreements between you and the claims administrator over whether your injury or illness happened on the job, the medical treatment you receive and whether you will receive permanent disability benefits. DWC-1 Form
If the work status slip is unclear or missing completely, contact the MPA Return to Work Coordinator for assistance getting the information.
Report the injury to your employer by telling your supervisor right away. If your injury or illness developed over time, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need. If your employer does not learn about your injury within 30 days and this prevents your employer from fully investigating the injury and how you were injured, you could lose your right to receive workers' compensation benefits.
Your local I&A officers are a great resource and their services are free. They are not there to act on your behalf as an attorney would, but they'll help you understand how to act on your own behalf. Attend a free seminar for injured workers at a local DWC district office for a full explanation of workers' comp benefits, your rights and responsibilities. You can also make an appointment with an I&A officer and speak to them privately at your convenience.
In addition, there is a lot of information on the I&A page of the DWC's website. Check out the fact sheets and guides for injured workers. The fact sheets provide answers to frequently asked questions about issues affecting your benefits. The guides will help you fill out forms you may need to get a problem with your claim resolved at the local DWC district office.
DWC District Office