Definition of Health Care Reasonably Required
Health care reasonably required is a term that is used in Texas workers' compensation cases. It is used in reference to health care that is regarded as being effective and clinically appropriate for an employee's work-related injury in keeping with evidenced-based medicine. Evidenced-based medicine is defined as being the current best quality medical and scientific evidence that is formulated from credible scientific studies, and practice and treatment guidelines in making decisions concerning the care of an injured worker. It is integrating individual clinical expertise with the best available external clinical evidence from systematic research. However, critics say that some of the guidelines of evidence-based medicine are not necessarily scientific or evidence based.
When that evidence is not available, health care reasonably required is considered to be using generally accepted standards of medical practice that are generally recognized and accepted in the medical community. In other words, it is getting the right health care for the work-related injury that you have sustained. It is receiving health care that is looked at in the medical community as being the right and appropriate health care for your injury. If you are an injured worker and you get health care that is not considered to be health care reasonably required, you may have to pay for that health care. It also may cause your workers' compensation benefits that you have been receiving to be stopped.