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your employer or the claims administrator has not created or selected an (Medical Provider Network-MPN),usted puede cambiar a otros midicos
<br /> MPN. dentro eo Is MPN desputs de Is primers visits.
<br /> Disclosure or Medical Records: After you make a claim for workers' • Si usted esti recibiendo tratamiento on un Organization de Cuidado Medico
<br /> compensation benefits,your medical records will not have the same level of (Healthcare Organization-HCO),es posible cambiar al menos una vez a otro
<br /> privacy that you usually expect.U you don't agree to voluntarily release medical midico dentro de la HCO.Used puede cambiar a un m6dico fuera de Is
<br /> records,aworkers'compcnsation judge may decdewhat reeordswill be released. HCO 90 0 180 dfas despuis de quo su lesi6n es reportada a su empleador
<br /> If you request privacy, the judge may "seal" (keep private)certain medical (dependiendo de si usted esti cubierto por on seguro mMco proporcionado
<br /> records. por su empleador).
<br /> Problems with Medical Care and Medical Reports:At some point during your • Si used no esti recibiendo tratamiento on una MPN o HCO y no hizo una
<br /> claim,you might disagree with your PTP about what treatment is necessary.If designaci6n previs,used puede cambiar a un nuevo medico una vez durante
<br /> this happens,you can switch to other doctors as described above.If you cannot los primeros 30 dfas despots de quo su lesi6n es reportada a sr empleador.
<br /> reach agreement with another doctor,the steps to take depend on whether you are P6ngase on contado con el administrador de reclamos Para cambiar de
<br /> receiving care in an MPN,HCO,or neither.For more information,see"Learn medico.Despuds de 30 dfas,puede cambiar a un m6dico de su eiecci6n si su
<br /> More About Workers'Compensation,"below. empleador o el administrator de reclamos no ha creado o seleccionado una
<br /> If the claims administrator denies treatment recommended by your PTP,you may MPN.
<br /> request independent medical review(IMR)using the request form included with Divulead6n de Exoedlentes M6dlcos:Despu6s de quo Ud.presente un reclamo
<br /> the claims administrator's written decision to deny treatment.The IMR process is pare beneficios de compensaci6n de trabajadores,sus expedientes m6dicos no
<br /> similar to the group health IMR process,and takes approximately 40(or fewer) tendrin el misno nivel de privacidad quo used nonnalmente espera.Si Ud.no
<br /> days to arrive at a determination so that appropriate treatment can be given.Your esti de acuerdo on divulgar voluntariamente los expedientes medicos,on juez de
<br /> attorney or your physician may assist you in the 1MR process.IMR is not compensacion de trabajadores posblemente decda qu6 expedientes serin
<br /> available to resolve disputes over matters other than the medical necessity of a revelados.Si usted solicits privacidad,es posible quo el juez"selle"(mantenga
<br /> particular treatment requested by your physician. privados)ciertos expedientes m6dicos.
<br /> If you disagree with your PTP on matters other than treatment,such as the cause Problemas eon In Alencl6n MMka v los Informes M6dicos: En algfin
<br /> of your injury or how severe the injury is,you can switch to other doctors as momento durante su reclamo,podrfa estar on desacuerdo con su PTP sobre qu6
<br /> described above.If you cannot reach agreement with another doctor,notify the tratamiento es necesary. Si esto secede,used puede cambiar a otros mddicos
<br /> claims administrator in writing as soon as possible.In some cases,you risk losing como so describe anterionnenle. Si no puede Ilegar a on acuerdo con otro m6dico,
<br /> the right to challenge your PTP's opinion unless you do this promptly.If you do Jos pasos a seguir dependen do si usted esti recibiendo atenci6n on una MPN,
<br /> not have an attorney,the claims administrator must send you instructions on how HCO o ninguna de has dos.Para miss informaci6n,consulte Is secci6n"Aprenda
<br /> to be seen by a doctor called a qualified medical evaluator(QME)to help resolve Mis Sobre Is Compensaci6n de Trabajadores,"a continuaci6n.
<br /> the dispute.If you have an attorney,the claims administrstor may try to reach Si el administrador de reclamos niega el tratamiento recomendado por su PTP,
<br /> agreement with your attorney on a doctor called an agreed medical evaluator puede solicitar una revisi6n medcca independiente(Independent Medical Rene—
<br /> (AME).If the claims administrator disagrees with your PTP on matters other than DM utilizando el formulario de solicitud quo se incluye con Is decisi6n por
<br /> treatment,the claims administrator can require you to be seen by a QME or AME. escrito del administrator de reclamos negando el tratamiento.El proceso de la
<br /> Psvment for Temporary Disability(Lost Wares):If you cant work while you IMR es parecido al proceso de Is LVR de un seguro midico colectivo,y tarda
<br /> are recovering from a job injury or illness,you may receive temporary disability aproximadamente 40(o menos)dies Para Ilegar a una determination de mancra
<br /> payments for a limited period.These payments may change or stop when your quo se pueda car on tratamiento apropiado.Su abogado o su medico le pueden
<br /> doctor says you are able to return to work.These benefits are tax-free.Temporary ayudar on el proceso de Is IM. La LNR no esti disponible Para resolver disputes
<br /> disability payments are two-thirds of your average weekly pay,within minimums sobre cuesiones aparte de Is necesidad medcca de un tratamiento particular
<br /> and maximums set by state law.Payments are not made for the first three days solicitado por su midico.
<br /> you are off the job unless you are hospitalized overnight or cannot work for more Si no esti de acuerdo con su PTP on cuestiones aparte del tratamiento,como Is
<br /> than 14 days causa de su lesi6n o la gravedad de Is lesi6n,usted puede cambiar a otros m6dicos
<br /> Stay at Work or Return to Work:Being injured does not mean you must stop como se describe anterionnente.Si no puede Ilegar a un acuerdo con otro midico,
<br /> working.If you can continue working,you should.If not,it is important to go notifique al administrator de reclamos por escrito tan pronto como sea posible.
<br /> back to work with your current employer as soon as you are medically able. En algunos casos,used arriesg perder el deredto a objetar a la opini6n de su PTP
<br /> Studies show that the longer you are off work,the harder it is to get back to your a menos quo hace eso de inmediato. Si usted no time on abogado, el
<br /> original job and wages.While you are recovering,your PTP,your employer administrador de reclamos debe enviarle instmcciones Para ser evaluado por un
<br /> (supervisors or others in management), the claims administrator, and your medico Ilamado on evaluador m6dico calificado(Quuakfied Medical Evaluaior-
<br /> attorney(if you have one)will work with you to decide how you will say at work QAH) Para ayvdar a resolver Is disputa. Si used tiene on abogado, el
<br /> or return to work and what work you will do.Actively communicate with your administrador de reclamos puede tratar de llcgar a un acuerdo con su abogado
<br /> PTP,your employer,and the claims administrator about the work you did before sobre on midico Ilamado on evaluador mbdico acordado (Agreed Medical
<br /> you were injured,your medical condition and the kinds of work you can do now, Evaluator-AAE).Si el administrator do reclamos no esti do acuerdo con su PTP
<br /> and the kinds of workthatyour employer could make available to you. sobre as ntos aparte del tratamiento,el administrador de rcclamos puede exigirle
<br /> Payment ror Permanent Disability:If a doctor says you have not recovered quo sea atendido por on QAE o AME,
<br /> completely from your injury and you will always be limited in the work you can Paeo nor Incaoadelad Temooral(Sueldos Perdldos):Si Ud.no puede trabajsr,
<br /> do,you may receive additional payments.The amount will depend on the type of mientras se esti recuperando de una lesi6n o enfermedad relacionada con el
<br /> injury,extent of impairment,your age,occupation,date of injury,and your wages trabajo, Ud. puede recibir pagos por incapacidad temporal por on periodo
<br /> before you were injured. limitado.Eros pagos pueden cambiar o parar cuando sr m6dico digs quo Ud.esti
<br /> on condiciones de regresar a trabajar.Esos beneficios son libres de Jmpuesos.
<br /> Supplemental Job Displacement Benelft(SIDS):If you were injured on or Los pagos por incapacidad temporal son dos lercios de so pago semanal promedio,
<br /> after 1/l/04,and your injury results in a permanent disability and your employer con camidades mfnimas y miximas esablecidas por las]eyes estales.Los pagos
<br /> does not offer regular,modified,or alternative work,you may qualify for a no se bacon durante los primeros tres dfas on quo Ud.no trabaje,a menos quo Ud.
<br /> nontransferable voucher payable for retraining andior skill enhancement.If you
<br /> sea hospitalizado una noche o no puede trabajar durante mist de 14 dfas
<br /> qualify,the claims administrator will pay the costs up to the maximum set by state
<br /> law. Permanezca en el Trabaio o Reereso al Trabalo:Estar lesionado no significa
<br /> que usred debe dejar de trabajar. Si used puede seguir trabajando,usted debe
<br /> Death Benefits:If the injury or illness causes death,payments may be made to a hacerlo. Si no es asi,es importanle regresar a trabajar con su empleador actual tan
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<br /> San Joaquin County
<br /> Department of Public Works
<br /> County of San Joaquin Dept of Public Works IIPP Rev 2020-01-31.docx P a g e 25
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