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What to Do When Workers’ Comp Refuses to Pay for Your Necessary Medical Care

woman lying in hospital bed

If you become injured on the job and your work injury requires medical care, your employer’s workers’ compensation insurer will always be responsible for paying the whole of any necessary medical treatment which is reasonable.  However, you are not responsible for co-payments in these cases. Your medical providers are also prohibited by law from billing you the balance. Balance billing is entirely illegal, yet so many people aren’t aware that it occurs. It’s a practice where a medical provider may attempt to try and bill a patient for the difference between what the insurance company has paid them and the amount they would usually bill a patient who will not have any insurance in place.  Despite how there are workers’ compensation laws that mandate your employer’s workers’ comp insurer to pay for 100% of your work-related medical bills, this does not mean that will always happen or that they will always follow the law.

Related:  Why Workers’ Compensation Claims Get Denied

What To Do With The Medical Provider

For those injured in work and pay for health insurance, give all of your health insurance information to your medical provider as soon as you can. Instruct them to bill the health insurance in the rare event that the workers’ compensation insurer decides not to authorize necessary treatment. Your doctor or medical professional will know what will be needed.  Health insurers, in general terms, are not required to pay for any kinds of work-related injuries if workers’ compensation has issued a denial, the health insurer shall be required to pay for the treatment.  By trying to remember this, and doing it at the earliest opportunity, you can ensure the treatment is paid for on time.

businessman giving contract to woman to sign

Contact An Attorney As Soon As You Can

Although it might not seem important to do so, you should contact an attorney as soon as possible because they’ll be able to advise you best on how to file a claim for medical benefits. People at Invictus Law can get you started. First, you need to dispel any notion of attorney fees. If any medical benefits whatsoever have been denied by the workers’ compensation insurer (and you retain the services of an attorney to bring a claim for you, on your behalf), an attorney will be able to get the workers’ compensation insurer to pay for your medical treatment. It does not cost you anything.  The workers’ compensation insurer will have to pay your attorney’s fees, fully and inclusively. So if you’re sure you have the right insurance when the comp refuses to pay, you’ve got nothing to lose by using—or at least speaking to—an attorney.

Looking for an attorney right now in Orange County? Contact us at Invictus Law here!

Your bills can quickly add up in the case that you are forced to use health insurance when workers compensation declines, especially if you suffer a terrible injury that requires more medical care. This is usually seen in cases where physical therapy might be needed to help with getting the injured party back to working capacity. Imagine the costs of these if you were to have weekly sessions. For those who have been denied medical treatment by the workers’ compensation insurer and for whatever reason do not have a form of health insurance, the immediacy is even more crucial. You must contact an attorney right away because it can take up to 5 months to get your claim in front of a judge. Unfortunately, even in clear cases, only a judge at the Department of Industrial Accidents can order an employer and a workers’ compensation insurer to pay any medical benefits previously denied, for whatever reason, to the person injured at work.

Related:  How to Choose a Workers’ Compensation Attorney

Serious Injury

In some, unfortunate, situations a worker might get injured to the extent where they can’t go back to work for an extended period of timeif ever. In this case, you won’t be earning pre-accident wages. You might be entitled to a considerable amount of future weekly workers’ wages in the form of benefits, or in some instances, a lump sum settlement. These benefits are hugely important because they’ll be your lifeline if you have no other money coming in. Meaning you and your family will be able to survive during your period of disability. Yet, if your health insurance pays your medical treatment and you decide not to pursue payment of medical treatment through your workers’ compensation, any entitlement to future wage loss benefits could in some cases be complicated by the workers’ compensation insurer’s assumption (and if it progresses, maybe the judge’s) that if it was paid for by health insurance and you did not file a claim to compel the workers’ compensation insurer to pay for the treatment, that it was not work-related. Unfortunately, if this decision is reached, it means you are not entitled to any workers’ compensation benefits.

woman with yellow hard hat holding machinery

It’s not a pleasant situation to be in, but unfortunately, it’s one which crops up more than anyone would like. You need to be aware, know your rights and do your research. Speak to your colleagues and boss but always seek an attorney’s opinion because they’ll always have the definitive answers you need. Remember, the key thing to keep in your mind if worker’s compensation refuses to pay is that your worker’s compensation insurer is responsible for paying 100% of medical treatment. Things may be tough, and hard if they decide they don’t want to pay. Just remember you have the complete right to approach an attorney to get things sorted out. The sooner you do it, the better.

Related:  How Do Workers’ Compensation Liens Work?

Want to learn more about how workers’ compensation works? Check out our breakdown of your rights here.

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