Read on to find out what happens to medical bills when workers comp is denied, how Rosenfeld Injury Lawyers can help ensure your employer’s insurance company complies with legal mandates to ensure you receive the compensation you deserve, as well as alternatives you could resort to in the meantime.
What Happens to Medical Bills When Workers Comp Is Denied?
When workers comp is denied, the injured worker becomes immediately responsible for covering all medical treatment costs related to the workplace injury. This financial burden when workers comp denies disability benefits can immediately affect the worker’s personal life and create stress, especially if a severe work injury requires care from specialized medical providers.
In case of a successful claim, most plans cover medical expenses related to injuries or health issues incurred as a direct result of employment. However, the exact coverage varies by state and the level of risk the injured worker is exposed to in their job.
A denied claim doesn’t just affect your immediate financial situation; it can also have long-term repercussions, affecting your credit score and future employability. Being well-informed about the workers’ compensation system can empower you to take the proper steps in the event of a denial. This includes the following:
- Knowing your rights
- Legal obligations of your employer and insurance agency
- Options available for appeal
Reasons Why a Workers Comp Claim Might Be Denied
Workers comp insurance companies often deny work-related injury claims to minimize their financial liability. They may scrutinize the details of the worker’s injury case, looking for inconsistencies or gaps in evidence that can serve as grounds for denial.
Potential problems could range from questioning the validity of medical providers’ documentation to examining the circumstances surrounding workplace injuries.
- Lack of Evidence – There’s insufficient medical documentation to support the workers’ comp benefits case.
- Late Filing – The employee missed the deadline for filing the workers’ comp case.
- Employer Disputes – The company disputes the claim, stating the injury didn’t happen at work but occurred earlier, ranging from hours to years before.
Ways to Cover Medical Bills After Being Denied Workers Comp
Sometimes, what happens to medical bills when workers’ comp is denied is that an injured worker is forced to seek alternative means to cover medical costs.
The immediate concern is avoiding paying out-of-pocket costs for medical treatment, which could be financially devastating to the injured worker’s family. Sometimes, the medical provider may even refuse treatment unless a reimbursement agreement is in place or an upfront payment is made.
Below are different avenues, which can serve as a financial safety net to pay for medical bills when workers’ compensation benefits are denied.
Group or Personal Health Insurance
Group or personal health insurance coverage can be a lifeline when worker’s compensation falls through. However, using your health insurance can increase premiums and out-of-pocket expenses.
Some health insurance companies also require a reimbursement agreement clause, requiring you to pay back the insurance agency if you receive benefits later.
Medicare
For an injured worker who is eligible, Medicare can serve as a backup plan when workers’ comp benefits are not available. While Medicare can cover some healthcare costs incurred due to a workplace injury, it often doesn’t cover everything. You may still face some bills when workers’ compensation denies your case.
When considering it as an alternative, it is crucial to understand Medicare’s eligibility criteria and coverage limitations. Medicare often has gaps in coverage, requiring you to opt for supplemental insurance or make out-of-pocket payments to cover the full medical/health care cost.
Medicaid
If you’re an injured worker with a low annual income, Medicaid can be a viable alternative to workers comp for covering medical costs. However, Medicaid also has limitations; it may not cover all the care you need for your work-related injury.
Eligibility for Medicaid is determined by various factors, including your income level and the state where you reside. Knowing these criteria can help assess whether Medicaid suits you when the compensation system denies your case.
Why Workers Comp Alternatives Should Be the Last Resort
While alternatives to workers’ compensation can provide some relief when your claim is denied, they should ideally be your last resort. Relying on these alternatives often comes with financial drawbacks, such as increased insurance premiums, out-of-pocket expenses, and potential gaps in coverage.
Moreover, turning to other options like personal insurance or government programs like Medicare and Medicaid can complicate your personal affairs, as these routes may involve stringent eligibility criteria and reimbursement agreements.
Therefore, your primary focus should be exhausting all avenues to secure workers’ comp medical benefits through appeals or legal assistance.
What to Do If You’ve Been Denied Workers Comp
If your claim has been denied, acting swiftly and strategically is crucial, as your subsequent actions can significantly impact your financial well-being.
While the denial may feel like a setback, it’s not the end of the road. Various options are available to challenge the decision, ranging from claim adjustments and hearings to involving arbitrators and exploring disputed claim settlements.
Claim Adjustment
This is the first step in contesting a denial. Just because your initial claim was denied doesn’t mean the discussion is over. Start a dialogue with the insurance company. Sometimes, minor misunderstandings or errors can be cleared up through simple communication without the need for formal processes.
Hearing
This is where you can present evidence to support your claim. If the claim adjustment doesn’t lead to a resolution, you can request a hearing. This is your chance to present your case in a more official setting. Make sure you gather all necessary documentation and consider consulting with an expert who can guide you through the process.
Arbitrators
If a hearing still doesn’t resolve the issue, arbitration is the next logical step. An arbitrator is a neutral third party who can mediate between you and the insurance company. They will review the details of the case and make a decision. Remember, in some cases, their decision might be binding, meaning you can’t challenge it in court later on.
Disputed Claim Settlements
This is the final step if all else fails. Even if the insurance company denied your initial claim, they might be open to a negotiated settlement. This could be a win-win, sparing both sides the time, effort, and uncertainty of continued legal battles.
How a Lawyer Can Help
If you’ve been left to pay for your medical bills after being denied workers comp, securing legal representation can be a game-changer for your case.
Rosenfeld Injury Lawyers can provide comprehensive support in navigating the complex steps required to contest a denial. We can help you collect all necessary documentation to strengthen your case and advocate for your rights during hearings and negotiations.
Our workers’ compensation lawyers operate on a contingency fee basis, meaning you won’t pay unless we win your case. Call us at (888) 424-5757 for a free consultation to explore your options.