California Self‐Insurance Plans (SIP) Exam

The main idea is that medical benefits under California workers’ compensation cover all reasonable and necessary medical treatment to cure or relieve the effects of an injury, including devices and prostheses needed because of the injury. In this scenario, two items stem from the same work-related incident: the finger amputation requires medical care and possibly a prosthesis or related stump care, which is clearly payable. The prescription glasses, if they were broken as a result of the incident and are prescribed for the employee, can be considered a medical device needed for treatment or for the employee to function while healing. Therefore, both the glasses and the finger amputation-related care are payable. Prorating or paying only one item isn’t appropriate when both are necessary to treat or relieve the injury.