Medical Benefits

Medical benefits are provided for reasonable and necessary medical care that is related to your work-related accident or illness. Some of the covered benefits include office visits, chiropractic care, dental care, prescription medications, surgical care and durable medical equipment. Except for hospitals, payments are made according to Utah's fee schedule. You are not responsible for any co-payments or balance due after our payment, as long as you receive medical care within WCF's PPO network and the state of Utah.

Pre-Authorization
Many procedures and treatment programs, including but not limited to surgeries, chiropractic care and physical therapy, must be pre-authorized by WCF to be covered. Please check with your claims adjuster to find out what medical treatments need to be pre-authorized and how your treating physician can request that authorization.

Preferred Provider Organization
WCF has an agreement with a network of hospital and physicians that offer quality care at discounted rates. Important Notice: If you do not receive treatment from a PPO hospital, you are responsible for any excess fee charged by the non-PPO hospital. Our PPO consists of any WorkMed clinic, any IHC facility and University of Utah Medical  Center. For a list of approved providers click here. 

Prescription Medication
We provide a prescription card for you to use to obtain medications related to your claim. This allows the pharmacy to bill us directly with no out-of-pocket expense to you.

Changing Physicians
You are entitled to change physicians one time without prior authorization from WCF or the Labor Commission. Changing from an emergency room is not counted as a change, nor are referrals from your treating physician. Please contact your claims adjuster if you wish to change treating physicians. You are liable for any treatment received from an unauthorized treating physician.

Mileage
We will reimburse you for mileage while traveling to and from medical treatment. Please request travel reimbursement in writing and include dates, roundtrip mileage and destination.

Emergency Room Treatment
Once treatment with a physician is established, emergency room visits are prohibited under Utah Labor Commission Rule R612-2-9. This rule does not apply to cases of threat to life or limb and /or direct referral from your treating physician. Injured workers who fail to comply with this rule will be held responsible for all charges associated with the emergency room care. Avoiding emergency rooms will provide consistent quality care with a physician familiar with your injury.

Concurrent Care
Generally, we will not pay for similar treatment from more than one medical provider. However, under certain circumstances, it may be authorized. Please contact your claims adjuster for pre-authorization.

Receiving Treatment Outside of Utah
Prior to leaving Utah, you will need to file an "Employee Notification of Intent to Leave Locality" form with the Labor Commission. When you receive medical treatment outside of Utah, your billings are still paid according to Utah's fee schedule. However, any balance will be your responsibility.