Which Medical Costs Does Workers' Compensation Cover?

If you are injured on the job and entitled to workers' compensation benefits, your employer (or its insurance company) is required by law to provide you medical treatment to address the health problems caused by your injury. This treatment does not have maximum dollar limits, nor does it have deductibles or copayments.

What Would Your Employer Pay For?

Their responsibility to you includes all things medically necessary to allow for the best treatment possible, including:

  • Doctor visits
  • Prescriptions
  • Therapy
  • Laboratory testing
  • Nursing care, if required

It may also include durable medical equipment provided to you at no cost, including mobility assistance devices where required. For very serious injuries it may also include home nursing and modifications of your home or vehicle. If hospitalization and/or surgery is necessary for your injury, the cost associated with that will be paid by the insurance company and payment arrangements are made directly in advance between the hospital and the insurance carrier.

Expenses incurred for trips to and from medical treatment (parking and mileage) are reimbursed. You will be asked to keep a careful record of your visits to medical professionals and the round-trip mileage.

The insurance company may also be required to treat other health problems you may have if treatment for those problems is medically necessary to allow for treatment for your injury. Common examples are treatment for pre-existing diabetes or provision of a weight loss program in anticipation of surgery.

Insurers May Dispute Your Treatment Plan

Should the insurance company dispute the recommendations of your primary treating physician, the reports will be submitted to utilization review. This review determines whether the treatment falls within guidelines adopted by the Department of Industrial Relations and whether the treatment is reasonable and necessary.

If the utilization review physician determines that your doctor's treatment recommendation is not appropriate, you can submit this decision for independent medical review for another look. The insurance company is not required to pay for treatment that has not been preapproved except in extreme emergency situations.

You may be required to select your treating physician from a provider network (called an "MPN"). If there is an MPN, you may change treating doctors within the network whenever you desire, and there is a provision for second and even third opinions regarding treatment from within the network itself should you desire.

Under present law, medical treatment disputes may not normally be heard by a judge. Nor may such disputes be determined by a neutral physician unless the parties agree to be bound by his or her opinion.

Unless you settle your workers' compensation case by compromise and release, medical treatment continues to be available, as needed, for your lifetime. The lifetime anticipated cost of medical treatment to cure or relieve from the effects of your injury may far outweigh the value of projected disability payments. For settlements, the value of the medical treatment must be factored into the settlement amount.

Get The Medical Care You Need To Recover

Your case might not be fully resolved once you file your workers' compensation claim. You will still face a long road ahead as you heal or adjust to your work-related injury or illness. Law Office of Howard J. Stevens, APC, is continuously committed to your medical and economic recovery. Allow us to help you secure benefits and stand up to insurers to protect your rights.

For prompt assistance to seek benefits, which may help you afford treatment, call us at 619-880-4501 or complete our online contact form. Our certified attorney understands how important the recommended medical care is for your well-being.