Boston Worker’s Compensation and Injury Blog

Getting Medical Treatment Paid by Workers’ Comp

Most injured workers who are approved for workers’ comp get benefits for medical treatment. However, there are certain criteria that must be met for the right medical care to be approved. Even more frustrating is the fact that insurers often drag their heels or outright deny that certain medical care is necessary at all.
If you were injured in an accident at work and need medical treatment that is being denied to you, turning to an attorney with extensive experience with workers’ comp cases is your best option.

What Medical Treatment Does Workers’ Comp Cover?

Most employers are obligated by law to provide employees with workers’ compensation. This insurance program provides injured workers with various benefits that include medical treatment, lost wages, funeral costs, and other benefits to qualifying family members when the employee dies as a result of a work-related accident.
Arguably, the most important benefit injured workers can claim from workers’ compensation is medical treatment since recovering is essential for one’s well-being and quality of life. But what medical treatment does workers’ comp cover?

Medical treatment covered by workers’ comp includes hospital or clinic visits, prescribed medications, surgery, and medical equipment such as crutches or a wheelchair. It is important to note that you have to opt for a hospital or clinic, and a physician authorized by your employer’s insurance company.
Whether your employers’ insurer is denying you payment for specific medical treatment you need, have already gotten, or denying all benefits completely, the best thing to do is to contact a workers’ comp attorney for advice and legal representation.

Guidelines for Medical Treatment Payment

In Massachusetts, as in most states, workers’ compensation should pay for medical treatment that is considered to be “reasonable and necessary.” But it is important to understand that this does not happen automatically. Your physician or other medical provider must adhere to specific guidelines for the insurer to process payment.

These guidelines include the following:

  • Written Request
    Your physician or other medical provider has to send a written request for authorization to your employer’s insurance company (or the insurer’s utilization review provider) regarding the medical treatment in question. A phone call is not enough.
    After the written request for authorization has been submitted, the insurance company’s utilization review provider will review it to decide whether the treatment in question is “reasonable and necessary.”
  • Decision
    If the insurer’s utilization review approves the request for treatment, it may then be reviewed by a claims adjuster who decides whether it is “casually related to work” or not. If the request is denied, you can turn to a workers’ compensation attorney for help.

How to deal with Medical Bills When Workers Comp Is Denied

The importance of medical treatment when employees suffer severe injuries on the job cannot be understated. Without this medical care, the injured worker will not recover properly and can even get worse. Unfortunately, insurance companies are for-profit businesses and always look for ways to avoid paying more than they have to and even nothing at all if they can get away with it.

It is not uncommon for insurers to unjustly deny payment for medical treatment injured workers have already undergone and are being billed for. So how do you deal with medical bills when workers’ comp is denied?

Some of the options injured workers in this situation can opt for include:

  • Personal Health Insurance
    If you have personal health insurance provided by your employer or otherwise, you may be able to turn to them for help with your medical bills. However, a lot of health insurance providers will use the very same reasons your employer’s insurer did for denying payment of medical care.
  • Negotiate with Your Employer
    If you do not have health insurance and your employer is conscientious, you may be able to negotiate payment or partial payment for your medical bills. Since your injuries are work-related, this is an option worth pursuing but don’t hold your breath. Most employers will outright refuse this, especially if they are paying for workers’ comp insurance and expect them to take care of it.
  • Contact a Workers’ Compensation Lawyer
    In the end, your best option is to contact a workers’ compensation attorney who will use all legal means necessary to get your employer’s insurer to pay for your medical bills if the case merits it.

How can a Workers’ Comp Attorney Help?

If medical treatment crucial to your recovery has been unjustly denied, you might be exploring other options to pay for it. You really should not have to pay for that treatment if you have a legal right to it through worker’s compensation. This might lead you to ask, “How can a workers’ comp attorney help?

An experienced workers’ comp attorney can help injured workers get the medical (and other) benefits they deserve. Although initially filing for these benefits after being injured on the job is an easy task, things get a lot more complicated when insurers refuse to pay.

Your workers’ comp lawyer can help you fill out important documents properly, avoiding unnecessary obstacles that will make the process longer and more frustrating. Your lawyer will also help you obtain critical documentation from doctors and others that can help you get a favorable outcome. Most importantly, a qualified workers’ comp attorney knows every single trick insurance companies use to deny claims and how to deal with them.

Get in Touch Right Away

We believe that every injured worker who is entitled to workers’ compensation benefits deserves them. It is tragic when insurance companies outright refuse to pay for medical treatment workers need to get better.

If this has happened to you, it is essential that you contact us as soon as possible so that we can fully examine all the circumstances of your case and advice you accordingly.
Get in touch with us right away at the Law Office of Robert E Frawley by dialing (617) 523-2929.

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