Who Should Pay the Medical Bills for a Work-Related Injury?

On Behalf of | Apr 26, 2023 | Workers' Compensation |

If you’re the victim of a work-related accident, you might be facing a long recovery. Meanwhile, who’s paying those medical bills that are piling up while you’re out of work?

If you said workers’ compensation, you’re correct. But workers’ comp regulations often favor employers and insurers, and the process can be intimidating.

Here’s what you need to know about your rights to compensation if you’ve been injured on the job.

What are your rights if you’ve suffered a work-related injury?

You have the right to pursue a workers’ compensation claim without hindrance or retaliation and the right to appropriate medical treatment. You also have the right to return to your job with the approval of your doctor or to file for disability if you’re too injured to return to work. You also have the right to appeal denials of your claims and to retain a lawyer if you need one.

What medical bills are covered by workers’ comp?

If you’re eligible, workers’ compensation will pay your medical bills and insurance deductible. Though it varies from state to state, the losses covered most commonly by workers’ compensation include the following:

  • A percentage of lost wages
  • Compensation for time off taken to attend medical appointments
  • Permanent impairment benefits
  • Rehabilitation services or therapy
  • Basic diagnostic tests
  • Medication prescribed for your injury
  • Doctor visits and checkups
  • Tests and diagnostic procedures
  • Surgery, if required
  • Transportation expenses, including mileage and gas, for attending medical appointments

Workers’ compensation will almost always cover emergency room care, even if it means surgery. So, if you receive a bill later in the mail, it’s best to forward it to your insurer and make sure that your healthcare provider has your workers’ compensation claim information.

When coverage for medical treatment is denied

Medical treatment must meet three criteria to qualify for coverage by workers’ comp:

  • It must be provided by a doctor authorized by the employer’s insurance company
  • It must be reasonably necessary to improve or cure the medical problem and relieve any accompanying pain
  • It must bill for services following the workers’ compensation regulations of your state

Guidelines provide details on the frequency and extent of the treatment and how long the care is necessary. In some instances, surgeries or diagnostic tests considered unnecessary won’t be covered. Alternative or experimental procedures are rarely covered. Neither is psychiatric care or payments for over-the-counter medications or medical supplies. In fact, anything not specifically recommended by your treating physician is likely to be denied.

If disputes arise regarding whether a treatment is necessary, reasonable, and connected with the injury, medical benefits are often delayed by a “utilization review.” That means that a qualified medical reviewer (QME) will evaluate whether the treatment or medication is covered by workers’ compensation.

Never skip medical care just because you think it might not be covered or because your claim was denied. In many instances, even if you end up paying out of pocket for medical treatment for your work-related injury, you may be entitled to reimbursement.

How can a workers’ compensation lawyer help?

If you’ve suffered a work-related injury, you need to make sure that you receive all the benefits the law allows. Sure, you could advocate for yourself, but you might make a mistake that could hurt your claim. A lawyer with experience in workers’ compensation claims can help you in the following ways:

  • Dealing with workers’ compensation fee guidelines
  • Advising on disputed claims
  • Negotiating payment for medical bills
  • Applying for disability, if necessary
  • Filing a claim if your employer retaliates against you
  • Handling insurance paperwork

In short, a good workers’ comp lawyer can help you get the money and benefits you deserve. If you’ve suffered a work-related injury and are worried about medical bills, the lawyers at Hunter and Everage can help.

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