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What Happens To Medical Bills When Workers’ Comp Is Denied?

If you are injured on the job, the most reasonable thing to do is submit a workers’ compensation claim to seek reimbursement for your medical bills and lost wages.

After filing a workers’ compensation claim, the majority of injured workers are able to collect compensation. However, 5% of all workers’ compensation claims are denied. When this happens, most injured workers do not know what to do to pay their medical bills and other out-of-pocket expenses. When a workers’ compensation claim is denied, the injured worker is financially liable for their medical care.

Fortunately, injured workers have some options for paying for their hospital bills. Nonetheless, a refused workers’ compensation claim is uncommon; if your claim was denied, you can always appeal the decision.

Hiring an expert workers’ compensation attorney can improve your chances of winning your case. A workers’ compensation lawyer will give you legal advice and thoroughly investigate your case to determine what was wrong when the case was initially filed.

Understanding the Fate of Medical Bills When Workers’ Comp Claims Are Denied
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If my workers’ compensation claim is denied, how can I get medical care?

There are different methods that can be used to get medical care if your workers’ compensation claim is denied. These are the most common:

Group health insurance

Workers who have suffered a work injury and had their workers’ comp claim denied can opt to use their group health insurance or their spouse’s group health insurance to pay for their medical treatment. Most group health insurance companies will provide health care coverage if the insured or the insured’s spouse has a workers’ compensation case that is being disputed. To be able to use this coverage, the injured worker will have to submit a “Notice of Dispute”.

Keep in mind that if you use a group health insurance coverage to pay for your medical treatment, you will have to sign an agreement that states that you will pay them back if a comp settlement is awarded. If you are working with a workers’ comp lawyer, they can negotiate with the group health insurance carrier to minimize the amount of money you have to pay them back if you receive compensation.

Medicaid

The second option that injured workers can opt to use to pay for their medical bills is Medicaid. Medicaid is the country’s public health insurance program for people with low income. To be able to use Medicaid coverage, the person injured will have to demonstrate that they are from a low-income bracket.

Medicaid is usually free, with no premiums or deductibles. However, in some states, it is permitted to require a share of the cost. The downside to Medicaid is that the program will not pay high rates. That will cause the medical treatment that you will be able to access may not be of high quality.

Furthermore, not every hospital or medical provider will accept Medicaid. Therefore, you will spend more time trying to locate a hospital or clinic where you can get medical treatment.  

Medicare

Medicare can be another option to get medical treatment if the injured worker is not able to use group health insurance coverage and does not qualify for Medicaid coverage. Medicare is a federal health insurance program for persons aged 65 and up, as well as some younger people with impairments and those with end-stage renal disease.

To be able to use Medicare, the person who was hurt at work needs to be approved for Social Security disability benefits. Nonetheless, even if the injured worker is approved for these medical benefits, they will need to wait 29 months from the date of the disability to be able to use Medicare coverage. An important benefit that Medicare has over Medicaid, is that Medicare is accepted by most hospitals and medical providers.

Health insurance

Using your own health insurance is another option. This is, however, not the best option. Most health insurance plans have deductibles that you may not be able to afford if you are unable to work.  But, if you have exhausted every other option, using your own health insurance can help you get medical treatment.

It is possible that the insurance carrier will try to recover the money they paid to cover your medical expenses if you receive workers’ compensation if the denial is reversed. 

Exploring Options for Managing Medical Bills After a Workers’ Comp Denial
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What Happens If I’m Fired During My Claim Process?

If you are fired while your workers’ comp claim is in process, you need to contact a workers’ comp attorney as soon as possible. Your compensation benefits may be affected if you get fired. Nevertheless, firing a worker while a compensation claim is in the process is something very suspicious.

Your lawyer will investigate if the cause of your firing is related to your claim. If that is the case, you can take legal action.

Who pays my workers comp medical bills if my claim is disputed?

If your workers’ comp claim is being disputed your medical bills can be paid by your group health insurance or the group health insurance of your spouse if it offers coverage for immediate family members. You might also utilize your own health insurance. Although, this last option is not recommended. Keep in mind that in most cases, you will need to agree to pay these insurance carriers back what they spent if you receive a workers’ comp settlement. 

Navigating the Situation: Medical Bills After a Denied Workers’ Comp Claim
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Which type of workers’ compensation claim is easiest to process?

The easiest type of claim to process is medical-only. Medical-only means that the injured worker will be reimbursed only for their medical expenses. Typically, the injured worker can return to work on the same day or the day after the incident.

Therefore, they will not need to be compensated for lost wages. Normally, these claims happen when the worker suffers a mild workplace accident that does not require complex and costly medical treatment. 

What is the biggest workers comp settlement?

Workers’ compensation settlements can range from thousands to millions of dollars. It is determined by the severity of the workplace injuries as well as the expense of medical treatment.

Workers’ compensation is unlimited and can be paid for the rest of one’s life. It is also possible to receive compensation in the form of a lump sum payment, but the sum must cover future medical bills.

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Do you get annual leave if you’re on workers’ compensation?

While on workers’ compensation, the majority of employees do not accrue annual leave. 

Who is required to provide workers’ compensation coverage?

Employers are required to provide workers’ compensation coverage. That is why it is crucial to fight for your rights. If your employer forces you to use other types of coverage to pay for your medical bills caused by a work-related injury, contact a workers’ compensation attorney immediately.

The attorneys at Greenberg & Stein P.C. can help you fight for your rights. Do not bear the entire financial burden caused by an accident when you are not responsible for it. Our legal team will do everything to make sure you can receive the compensation you deserve. Contact us at 212-681-2535 to schedule a free consultation to review your case. 

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