By GNGF Design/Development on September 27th, 2024 in Uncategorized
Workers’ compensation benefits include extensive medical coverage that is necessary for you to heal from your injuries and achieve the best possible outcome based on your diagnosis.
If you’re injured on the job and your claim is approved, workers’ comp will cover:
Diagnostic Tests
Doctors must be able to run tests and provide you – and the insurance company – with a full determination of your condition. Any tests that the doctor runs are covered as long as they’re necessary.
What is necessary?
Any tests that are requested must relate to your injury. A few of the most common diagnostic tests that are covered in your claim are:
- X-rays
- MRIs
- CT scans
If you are seeking medical care from an alternative medical provider, such as an acupuncturist, and they order a diagnostic test, this may not be covered.
Durable Medical Equipment
Durable medical equipment (DME) may be required for you or your caregiver. For example, if you break your leg, you may need crutches. Lung injuries may require you to use an oxygen tank temporarily, and this would also be covered.
Workers’ comp may not approve all DME, but most will be covered.
A few pieces of DME that are covered include:
- Canes
- Crutches
- Walkers
- Chair lifts
- Commodes
- Wheelchairs
Emergency Room Visits
If you were rushed to the emergency room after the accident at your workplace, the costs will be covered, too. Subsequent emergency room visits due to the injuries that you sustained as a result of the accident at your workplace will also be covered.
If the emergency room visit is unrelated to your accident or injuries, it will not be covered.
Prescriptions
Any prescriptions that your doctor prescribes will be covered. Prescriptions must relate to your injury and the treatment plan that you’re following. If you took medication previously, that isn’t related to your injuries, this will not be covered.
Therapy
Physical and occupational therapy, related to your limitations due to your injuries, will be approved. Even visits to the chiropractor or a massage therapist may be covered by workers’ comp.
Your doctor will need to recommend these treatments and may be required to show that you require ongoing care.
Follow-up Visits to Your Doctor
Injuries often require multiple follow-up visits with a doctor, and these visits will be covered, too.
Travel Expenses
You may need help getting to and from your doctor’s appointments or therapy. For example, perhaps you cannot drive or walk, so you need to have a wheelchair van come and take you to your appointments.
If you have all of the mileage counts and receipts for these expenses, they may also be covered.
Unfortunately, some services are excluded from workers’ comp.
Can Any Services Be Specifically Excluded?
While most medical expenses will be covered by workers’ comp, there are some services that may be excluded, such as:
- Alternative treatments, like biofeedback, acupuncture or naturalistic medications.
- Experimental or novel treatments that lack substantial scientific evidence
- Specialized care prescribed by a non-specialist
Natural and alternative treatments are typically not covered by workers’ compensation because alternative medicine is not regulated or evaluated for its efficacy.
What Happens if Workers’ Comp Won’t Pay for Your Medical Expenses?
If the insurance company won’t cover certain medical expenses, the bills won’t disappear. So, what can you do?
You can appeal the decision, or you can find an alternative route to cover these costs.
If you’ve been denied coverage, the insurance company will send you a letter explaining their reasons for denying your claim. Their reasons can help you determine which steps to take next.
For example, you may not have been seeing the right provider. Your employer should provide you with a list of approved providers. Making a switch may solve the problem.
If your provider isn’t the issue, then you have a few other options available:
- You can appeal the decision at a formal hearing.
- You can use your own health insurance to cover your expenses. In many cases, insurance companies will cover the cost of disputed bills if you agree to reimburse them when you win your workers’ compensation case.
Appealing the insurer’s decision is complicated. For the best chances of success, you need an experienced attorney at your side to help you navigate each step.
An appeal will involve either mediation or a formal hearing in front of an administrative law judge. During the hearing, you will need to present evidence to support your case, and the judge will make a decision based on your arguments.
An attorney will know how to prepare for the hearing and gather evidence to support your case.
If you were injured on the job or your workers’ compensation claim has been denied, contact or call The Law Offices of Darwin F. Johnson today to schedule a consultation. We’ll hear your story and help you find the next steps to take with your claim.
