Cure and Medical Treatment Rights for Injured Seamen

For a qualifying seaman, the answer often starts with a benefit called cure. Under general maritime law, a vessel owner or employer owes medical care to a seaman who is injured or falls ill in the service of the vessel. That obligation has limits, and it depends on your status and the facts of your case. But it exists whether or not anyone was at fault.

Two things before anything else. First, if you have an urgent medical need, get medical attention. Do not wait for an authorization letter, and do not wait to talk to a lawyer. Second, if treatment your doctors recommend is being delayed, denied, or quietly left unpaid, contact The Young Firm for a treatment-specific review. We review these problems for seamen across Louisiana and the Gulf Coast from our New Orleans office. This page explains what cure covers, where the common fights happen, and what to gather so that a review of your situation is useful from the first conversation. For the broader picture of maintenance and cure benefits, start with our overview of maintenance and cure claims.

What Is Cure, and Do I Need to Prove Employer Fault?

Cure is the general maritime law obligation of a vessel owner or employer to pay for reasonable and necessary medical treatment for a seaman who is injured or becomes ill while in the service of the vessel. It is owed regardless of whether the employer was negligent, and it continues until the seaman reaches the point where further treatment will not improve the condition (often called maximum medical improvement or "maximum cure"). Cure is separate from maintenance, which pays daily living expenses, and separate from any damages a seaman may recover in a negligence or unseaworthiness claim.

That definition carries several qualifications, and each matters.

No proof of fault. The Supreme Court has long treated maintenance and cure as an obligation that flows from the employment relationship itself, not from wrongdoing. In Calmar Steamship Corp. v. Taylor, 303 U.S. 525 (1938), and again in Aguilar v. Standard Oil Co. of New Jersey, 318 U.S. 724 (1943), the Court described the duty as arising from the seaman's service to the ship, without regard to the employer's negligence and, within limits, even where the seaman's own conduct contributed to the injury. You do not have to show that a hatch was defective or a supervisor was careless to be entitled to medical care. Nor does the condition have to be caused by the work itself; an illness that surfaces while you are in the service of the vessel can qualify.

"In the service of the vessel." The condition must arise while you are subject to the call of duty as a crew member. That is a broad concept (Aguilar extended it to a seaman injured while on shore leave), but it is not unlimited, and it applies to seamen. Not every worker on the waterfront or offshore is a seaman. If your status is uncertain, that question has its own analysis; see Jones Act seaman status. Workers covered by the Longshore and Harbor Workers' Compensation Act have medical rights under a different statute, 33 U.S.C. § 907, with different rules on physician selection and authorization. Those rules do not govern a seaman's cure. See medical benefits under the LHWCA.

Cure is not a settlement. Cure pays for the treatment you need now to get better. It does not pay for lost future earnings, pain, disability, or the projected cost of care after you stop improving. Those are damages, which may be pursued through separate claims such as negligence or unseaworthiness. Read about Jones Act compensation and damages if you want to understand what a full claim can include.

Cure has an endpoint. The obligation runs until maximum cure, not for life. When and how that endpoint is determined is a frequent dispute, addressed on maximum medical improvement and benefit duration.

Maintenance is a different payment. If your question is about the daily rate you are receiving for room and board, that is maintenance, discussed at maintenance rates and living-expense payments.

Finally, employers raise defenses to eligibility: that you concealed a preexisting condition, that you quit or were fired, that you have already returned to work. Those defenses are addressed on maintenance and cure eligibility issues. The rest of this page assumes you are a seaman whose right to cure is not seriously in doubt, because the treatment problems below arise even when eligibility is undisputed.

Can Cure Cover Surgery, Testing, Physical Therapy, and Prescriptions?

Each of these can fall within cure. None of them is automatically paid simply because a clinician recommended it. The questions in every category are the same: Is this treatment connected to the injury or illness that arose in service of the vessel? Is it reasonable and necessary for that condition? Is the charge reasonable? Has maximum cure been reached? A recommendation from your doctor answers the medical question. Whether the employer is obligated to pay is a legal question that depends on how those four factors come out, and how they come out in a given case depends on your facts and on the court decisions that apply to them. What follows is practical guidance on what supports each kind of request, not a set of fixed rules.

Surgery

Surgery recommended to improve a qualifying condition can be payable as cure, subject to the necessity, reasonable-charge, and maximum-cure questions above. The strongest surgery request has more than a one-line recommendation. It has the surgeon's explanation of why this procedure is expected to improve your condition, what conservative treatment has already been tried, what imaging supports the diagnosis, and what the procedure and facility will cost. When the company says it needs "more information," these are the records most likely to answer that request. Gather them early, because a surgical date can depend on them.

Diagnostic Testing

Testing ordered to diagnose or guide treatment of a qualifying condition is the kind of expense a cure request can include. Expect an employer to treat testing ordered solely to build a lawsuit differently, and expect the purpose of any study to be questioned. The answer often turns on the ordering physician's stated purpose, so make sure the order or the clinic note says why the study was requested.

Physical Therapy

Prescribed therapy for a qualifying condition can be payable as cure for as long as it is still improving your condition. A common flashpoint is the point where the initial course ends and the therapist or physician wants more sessions. Progress notes matter there: are you still improving, or have you plateaued? A request for additional sessions is far stronger when the treating clinician documents measurable gains and explains what further therapy is expected to accomplish. There is no fixed number of sessions that cure covers; the question is whether continued therapy is still curative.

Prescriptions

Medication prescribed for a qualifying condition can be payable as cure, either through direct payment to the pharmacy or by reimbursing what you paid. A prescription problem may be logistical rather than a true dispute: the pharmacy has no payment arrangement on file, the claims administrator has not set one up, and you are paying cash or going without. Keep the prescription, the pharmacy receipt, and proof of payment. If a payment request was rejected at the counter, ask for whatever printout or reference the pharmacy can provide. If you cannot afford a medication and are considering stopping it, talk to the prescribing clinician first. Some medications should not be interrupted, and your clinician may have alternatives while payment is sorted out.

Direct Payment Versus Reimbursement

In practice, cure is handled two ways: the employer pays the provider directly, or the seaman pays and seeks reimbursement for documented out-of-pocket expenses. Direct payment is better for you when it works, because you never advance the money. Reimbursement means keeping every receipt and every explanation of benefits, and it means the employer may later argue that a charge was unreasonable. Do not assume that paying first is a condition of the employer's obligation; if you have already paid, keep the proof, and raise the question of reimbursement when your situation is reviewed.

Can I Choose My Own Doctor Instead of the Company Doctor?

This question deserves a careful answer rather than a slogan. You are generally free to consult any physician you choose. Whether the employer is obligated to pay that physician is a separate question, and the two are often confused.

Three Different Roles

It helps to separate the people who may examine you:

• Your treating physician. The doctor you see for care. You selected this doctor, or you were referred to them, and their job is to treat you.
• A company-selected treating physician. A doctor the employer arranged to treat you. This is still treatment, and this doctor still has a duty to you as a patient. But the employer chose the provider.
• An examining physician for the claim. A doctor the employer or its insurer asks to examine you, not to treat you, but to give an opinion about your condition, your need for treatment, or whether you have reached maximum cure. This is an evaluation, not care.

A great deal of confusion comes from treating these as interchangeable. A company doctor's treatment recommendation is not automatically wrong, and your own doctor's charges are not automatically payable. Whether a company-selected doctor is trustworthy depends on the doctor.

What Actually Determines Payment

When a seaman chooses a private physician and the employer refuses to pay, the questions courts and lawyers look at include whether the employer offered adequate medical care, whether the treatment obtained was reasonable and necessary for the qualifying condition, whether the charges were reasonable, and whether the seaman's departure from offered care was reasonable under the circumstances. These are fact questions. The answer for a seaman whose company doctor recommended surgery and who simply preferred another surgeon may differ from the answer for a seaman whose company doctor said nothing was wrong while the seaman's symptoms worsened. The federal appellate court for Louisiana, Texas, and Mississippi is the Fifth Circuit, and its decisions shape how these questions are answered in Gulf Coast cases. Before relying on a general statement about "the right to choose your doctor," get advice based on current Fifth Circuit law and your specific facts.

Changing Doctors

If you want to leave a company-arranged physician, understand why before you do it. A change based on a documented clinical reason (the doctor is not addressing a diagnosed problem, is not a specialist in the injured body part, or is geographically inaccessible) looks very different from a change with no explanation. Document the reason. If possible, get the referral or recommendation in writing from a clinician.

Specialist Referrals

A written referral from your treating physician to a specialist documents the medical reason for specialist care and carries the referring doctor's judgment with it. It does not, by itself, establish the employer's obligation to pay the specialist; that still turns on necessity, the reasonableness of the charges, and the applicable law. Keep the referral. If the company balks at paying a specialist your treating doctor referred you to, ask in writing whether the objection is to the specialist's necessity, the specialist's identity, or the specialist's charges. Those are different objections with different answers.

Second Opinions

A second opinion before surgery is common medical practice, and a request for one is reasonable in most circumstances. Whether the employer must pay for it is again fact-dependent. If you obtain one, make sure the consulting physician writes a report, because a second opinion that exists only as a conversation does you no good in a payment dispute.

Refusing Offered Care or Requested Examinations

Do not refuse offered treatment or a requested examination as a reflex. An employer may point to a refusal of offered care as a reason to dispute payment for the care you obtain elsewhere, and may point to a refusal of a requested examination as a reason to argue that benefits should end. Whether those arguments succeed depends on your facts and the governing law. That does not mean you must accept everything. It means the decision to decline should be made with advice, for a documented reason, not in the heat of frustration.

Fear of Consequences at Work

Many seamen worry that questioning the company doctor or asking about their own physician will cost them their job, their maintenance check, or their next hitch. That fear is real and we do not dismiss it. We also cannot promise that asserting your rights carries no professional risk. What documentation does is establish, plainly and with dates, what you asked for and how the employer responded. If you are weighing a treatment request against your standing at work, that is a decision to make with individualized advice rather than alone.

One last clarification: "choice of physician" and "authorization" procedures under the Longshore Act come from 33 U.S.C. § 907 and apply to LHWCA claimants, not to a seaman's cure.

My Surgeon Recommends Surgery—What If the Company Has Not Approved Payment?

When a recommended procedure cannot be scheduled, it is because three separate things have not lined up:

1. The medical recommendation. Your surgeon believes you need the procedure.
2. The payment decision. The employer, its insurer, or a claims administrator has agreed to pay for it, or has not.
3. The provider's scheduling requirements. The hospital or surgical center will not put you on the calendar until it has whatever it requires: a payment guarantee, a deposit, records, pre-authorization from whoever is paying.

"The company hasn't approved my surgery" describes a symptom. The problem may be at step two, but not necessarily. Sometimes the surgeon's office never sent the request. Sometimes the request went to the wrong adjuster. Sometimes the payer approved it and the facility is waiting on something else. Finding out which step is stuck is the first task, and the stall generally falls into one of three kinds:

• The clinical support is thin. The surgeon recommended the procedure, but the request that reached the payer was a one-line note with no rationale, no imaging, and no record of failed conservative care. The fix is medical documentation, and the fastest path runs through the surgeon's office.
• Payment responsibility is genuinely disputed. The employer contends the condition is preexisting, that you have reached maximum cure, that the charges are unreasonable, or that you are not a seaman at all. The medical file may be complete; the disagreement is legal, and it may need to be pressed formally.
• The scheduling barrier is administrative. The payer approved the procedure; the facility never received the approval, or requires a guarantee letter in a particular form, or has a records request outstanding. Nobody is refusing anything. Somebody needs to send the right document to the right place.

Here is a practical sequence for sorting out which one you are facing. It is not a legal requirement, and general maritime law does not prescribe a standardized authorization form or a fixed response deadline the way workers' compensation systems do. You can also seek a legal review at any point in this sequence; you do not have to finish it first.

• Identify who requested authorization, and what they sent. Ask the surgeon's office whether a request went out, to whom, on what date, and what documents accompanied it. Get copies.
• Confirm receipt. Ask the employer or claims administrator, in writing, to confirm that the request was received and on what date. Silence is easier to address once you can show the request arrived.
• Ask for the reason in writing. If payment has not been approved, ask specifically whether the issue is missing records, a dispute about medical necessity, an objection to the provider, a dispute about the cost, a question about your eligibility, or a position that you have reached maximum cure. Each of those has a different fix. A vague "under review" tells you nothing; ask what is being reviewed.
• Ask the provider what remains missing. The facility often knows exactly what it needs to schedule you. Sometimes it is a single document.
• Preserve dates. Keep a record of every proposed procedure date, every cancellation, and every note in which your surgeon describes the urgency or the consequences of delay. Let the clinician characterize the medical risk; do not guess at it yourself.
• Seek review when access remains blocked. If you still cannot get scheduled, or if the stated reason does not hold up, the dispute has moved from logistics to law. That is the point to have a maritime lawyer compare what was requested, the rationale that went with it, what response came back and when, and what the provider says it still needs.

You do not have to assume that paying for the surgery yourself is your only option, and you should not be told that it is. We also cannot promise that the company will approve payment, that you will be reimbursed if you advance the cost, or that any firm will fund treatment. What a lawyer can do is determine whether the delay reflects a legitimate dispute, a paperwork failure, or an unjustified refusal, and pursue the remedy that fits.

A single delayed authorization is not, by itself, bad faith. But a pattern of unexplained delay while a seaman goes without needed care can become part of a larger dispute about unpaid or terminated benefits. If that is where your case is heading, see when maintenance and cure is denied or stopped and, for the standards governing enhanced remedies, bad-faith failure to pay maintenance and cure.

Can Cure Include Travel Costs for Medical Treatment?

Travel expenses tied to necessary medical care can be part of a cure request, but each category of expense requires its own review, and none should be assumed payable simply because a trip occurred. Whether a particular expense is payable in your case is a question for individualized review. The core requirement is the same as for treatment itself: a documented connection between the expense and reasonable, necessary care for the qualifying condition, plus proof of the actual cost.

This is a practical concern along the Gulf Coast. A seaman who must travel from Houma, Morgan City, Cut Off, or the Mississippi coast to a specialist in New Orleans, Baton Rouge, Houston, or farther may face substantial transportation or overnight costs. A round trip to a spine surgeon or a pain-management clinic can be a full day and several hundred miles.

Transportation and Mileage

Mileage or fares for trips to necessary treatment can be included in a cure request. Keep a record of each trip: date, purpose (which appointment, with which provider), starting point and destination, and mileage or fare. Keep the appointment confirmation or the after-visit summary to prove the appointment occurred. If you used a rideshare, taxi, or public transportation because you could not drive, keep the receipt and, ideally, the clinical note indicating you were not to drive. General maritime law does not set a per-mile rate the way some benefit systems do; what is reasonable will be a matter of proof and, if disputed, argument.

Lodging and Meals

Overnight stays can be included in a request when treatment genuinely required them, and expect them to be scrutinized. They are supported by a medical reason (an early-morning procedure at a distant facility, a multi-day evaluation, a post-procedure instruction not to travel) and by receipts. A referral to a distant specialist helps show why the trip was necessary at all. Meals during treatment travel raise the issue discussed below.

Companion Expenses

If a family member had to drive you because you could not drive yourself, or had to accompany you because of your condition, document the reason, preferably through a clinician's note. Do not assume companion costs are automatically covered; expect them to be questioned, and treat the medical justification as essential.

Keep Travel Separate From Maintenance

Maintenance already pays for your daily food and lodging while you recover. A meal you would have eaten at home is not an additional treatment expense. The travel expenses that belong in a cure request are the ones caused by the treatment: the mileage you would not otherwise have driven, the hotel night you would not otherwise have needed. Claiming the same cost twice weakens the whole request.

There is no universal rule that travel must be preapproved, but notifying the employer in advance of a distant appointment and asking how it wants expenses submitted removes one common objection later.

What If the Company Doctor and My Treating Doctor Disagree?

When a company-selected physician and a seaman's treating physician disagree, neither opinion automatically controls. The dispute is resolved by examining the actual reports, the records and reasoning behind each recommendation, and the applicable law. Whether one physician's opinion is enough to end the employer's cure obligation depends on the basis for that opinion and the governing standards, and a seaman cannot compel payment simply by producing a contrary opinion.

Before you can evaluate a disagreement, you need to know what kind of disagreement it is.

A dispute about a particular treatment. Both doctors agree you are injured and still improving, but one recommends surgery and the other recommends more conservative care. This is a medical-necessity question about one intervention.

A dispute about whether you have reached maximum cure. One doctor says further treatment will improve your condition; the other says you have plateaued and any remaining treatment is palliative. This is an endpoint dispute, and it threatens the entire cure obligation, not one procedure. In Vella v. Ford Motor Co., 421 U.S. 1 (1975), the Supreme Court explained that the obligation continues until a medical determination that the condition is permanent and incurable is actually made, not from the moment the condition happened to become permanent. A doctor's declaration of maximum cure therefore carries real weight, which is why the content of that report and the basis for it matter so much. How a maximum-cure finding is challenged, and whether cure can resume if new treatment becomes available, is covered on maximum medical improvement and benefit duration.

Whatever the type of dispute, the practical steps are similar:

• Obtain both reports. You are entitled to your own medical records, and an examination report generated for your claim is usually obtainable through your lawyer if the employer does not provide it.
• Ask your treating clinician to explain, in writing, what the recommended treatment is expected to accomplish and why. A recommendation that says "further therapy is indicated" is weak; one that says "patient has gained 20 degrees of shoulder abduction over six weeks and additional therapy is expected to restore functional overhead reach" is strong.
• Compare what each physician actually examined. Did the company doctor review the same imaging? See you once for twenty minutes or treat you for months?
• Do not assume the cutoff is final because a letter says so.

If the employer has relied on the company doctor to terminate benefits outright, the broader dispute is addressed on when maintenance and cure is denied or stopped. If the employer is arguing that the condition was preexisting or that your employment ended, those defenses are covered on maintenance and cure eligibility issues.

Keep a Treatment Request Log and the Records Behind It

You do not need to understand maritime law to build a record that a lawyer can use. You need dates, documents, and a plain account of what happened. Start now, with whatever you have. Missing records are not a reason to delay an initial inquiry, and complete records are not a guarantee of payment; they simply make the problem visible.

The Request Log

A simple table, kept in a notebook or a spreadsheet, is enough:

Add a row every time a request goes out, a response comes in, an appointment is scheduled, or an appointment is cancelled. Note who cancelled it and the stated reason.

Medical Records

Collect what you can from each provider:

• Treatment orders, prescriptions, and referrals
• Reports from your treating physicians and from any examining physician retained for the claim
• Imaging reports and test results
• Physical therapy treatment plans and progress notes
• Cost estimates for proposed procedures
• Bills, statements, and explanations of benefits
• Pharmacy receipts and any record of a rejected charge
• Travel documentation: appointment confirmations, mileage notes, and receipts

Correspondence

Preserve every written exchange about treatment or payment: emails, text messages, letters, portal messages, authorization request forms, fax confirmations, and any denial or "additional information needed" letter. If a message confirms the company received your request, keep it; proof of receipt matters.

Telephone Calls

After any phone call with the employer, insurer, adjuster, or provider about payment, write down the date, who participated, and a factual summary of what was said. Do this the same day. Do not secretly record calls; a contemporaneous written note is what you need.

Protecting Your Records

Medical records are sensitive. Keep copies in one place, and when the time comes to share them with a lawyer, ask how the firm wants them delivered rather than attaching a full medical file to an unsolicited email.

Legal Sources and Limits of This Guide

The authorities below are the sources for the specific propositions attributed to them above: the no-fault nature of the obligation, its "service of the ship" basis, its endpoint, the existence of remedies for willful nonpayment, and the distinction between a seaman's cure and LHWCA medical benefits. They do not, by themselves, establish category-specific rules on surgery, testing, therapy, prescriptions, physician choice, or travel expenses. The discussion of those subjects on this page is practical guidance framed as the questions that arise in a dispute and the documentation that helps answer them; it is not a statement of settled rules.

• Calmar Steamship Corp. v. Taylor, 303 U.S. 525 (1938). Describes the scope of the shipowner's duty to provide maintenance and cure, its independence from fault, and its limits: the duty is to provide care and support during recovery, not to compensate for all future consequences of an incurable condition.
• Aguilar v. Standard Oil Co. of New Jersey, 318 U.S. 724 (1943). Explains the broad "service of the ship" basis of the obligation, extending it to a seaman injured while on authorized shore leave, and reaffirms that the duty does not depend on employer negligence.
• Vella v. Ford Motor Co., 421 U.S. 1 (1975). Addresses the endpoint of the cure obligation and the significance of an actual medical determination that a condition is permanent.
• Atlantic Sounding Co. v. Townsend, 557 U.S. 404 (2009). Recognizes that punitive damages may be available under general maritime law for an employer's willful and wanton failure to pay maintenance and cure. This page cites Townsend only to identify that remedies exist for the most serious refusals. It does not stand for the proposition that a delayed authorization warrants punitive damages, and the standards for that claim are discussed on bad-faith failure to pay maintenance and cure.
• 33 U.S.C. § 907. The medical-benefits provision of the Longshore and Harbor Workers' Compensation Act. It is cited to distinguish LHWCA medical rules from a seaman's cure, not as authority for a seaman's rights. Longshore and harbor workers should consult medical benefits under the LHWCA.

Three limits on this guide should be understood.

First, cure arises under general maritime law, a body of federal judge-made law. It is not governed by Louisiana's workers' compensation statute, its fee schedules, or its physician-choice rules, and it is not governed by the LHWCA. Readers who have encountered those systems should not assume their procedures carry over.

Second, the practical answers on physician choice, reasonable charges, refusal of offered care, and travel expenses depend heavily on decisions of the federal courts of appeals and district courts, and for Louisiana, Texas, and Mississippi cases that means the Fifth Circuit. This page does not cite those decisions individually. They are fact-specific and continue to develop, which is why statements here about how those questions are analyzed are deliberately framed as the questions courts ask, not as fixed rules. The outcome depends on the facts of each case and on the authority in force when your dispute arises.

Third, this guide is general information about maritime law. It is not legal advice about your situation and it is not medical advice. Whether you are a seaman, whether a particular treatment falls within cure, and whether an employer's refusal is justified are questions that require review of your facts by a licensed maritime attorney, and questions about your health require your physicians.

Ask The Young Firm to Review Your Delayed or Disputed Medical Treatment

If recommended treatment is stalled, a company doctor and your doctor disagree, or you are paying for care that you believe the vessel owner should be paying for, The Young Firm can review the problem. We handle maintenance and cure disputes for seamen from our office in New Orleans, serving injured maritime workers across Louisiana and the Gulf Coast. For the full scope of what these benefits cover, see maintenance and cure claims.

You do not need a complete medical file to start. It helps to have, or to be able to describe:

• Your employer, the vessel you were working aboard, and roughly when the injury or illness occurred
• The treatment that has been recommended and who recommended it
• Any upcoming procedure or appointment date, and any that has been cancelled
• What the employer, insurer, or claims administrator has said in response, in writing if you have it
• Whatever records, bills, receipts, or correspondence you have gathered so far

Bring what you have. If you have kept a request log like the one described above, bring that too. Ask us how to send medical records before attaching them to a first message.

We cannot promise that your surgery will be approved, that a particular bill will be paid, or that we will take every case. What we can offer is a review of where your treatment is stuck, whether the employer's position holds up under maritime law, and what options exist.

And again: if you need medical care now, get it. A legal review can wait a day. Some injuries cannot. When you are ready, contact The Young Firm to review your treatment dispute.