Saturday, December 9, 2023

What happens to medical bills when workers’ compensation is denied?

Must read

Any harmful situation that happens to you at work can be a headache. But a denial of workers’ compensation benefits can be highly stressful. Even if you make a claim, as usual, there may be a loss of freedom in your head. What happens to medical bills when workers’ compensation is denied may be the thing that bothers you most of the time.

From the outside looking in, this might seem like a terrifying situation. However, you don’t have to worry about that anymore. Many options are available to protect your medical bills even if workers’ comp is denied. We will give you clear guidelines about it.

There are a few things we will mention to you throughout our guide. What happens to medical bills when workers’ compensation is denied, and what options for workers’ comp can help you cover your treatment?

Refer: Best Medical Billing Clearinghouse Companies in 2022 for Medical Claims

How can workers’ comp be denied?

We call workers’ compensation the protection coverage for someone when their job duties are over. That way, you can be protected from severe workplace injury. Think of it like this. If the injury causes you to lose your earnings, you may be eligible for workers’ compensation benefits.

However, there may be various reasons for rejecting the relevant claim. That means Workers’ Comp may be due depending on the circumstances of your injury. Such cases are,

  • The injury does not interfere with your work
  • Pre-existing injury
  • The damage is unrelated to your work
  • The injuries are not severe enough to require medical treatment
  • Not containing accurate information related to your injury

Besides, there are several other reasons. Sometimes you may not be able to afford compensation for specific injuries. Imagine a scenario in which you are absent after the damage occurs. If so, you may not be tempted to provide benefits by the insurance company. 

The above denial will also apply if the injury is due to negligence. Think of a time when you were busy with personal affairs after an injury. In such a case, workers comp is denied.

When you make a successful claim, you must also have someone present at your workplace who can testify to the accident. You should also report it at the right time according to the correct parameters. Also, workers’ comp is denied if you commit a crime after the injury.

What medical bills does Workers’ Comp cover?

Workers’ comp pays all medical bills while treating someone’s work injuries. There are no restrictions on those bills, but there are some related sections. That includes emergency room treatments, doctor visits, MRI diagnostic studies, medications and rehabilitation treatments, X-rays, and hospital stays. And the rules for approving medical bills associated with those compensation claims vary from state to state. 

What should you do if workers’ comp is denied?

First, when you are injured on the job, you must file a claim to receive compensation for your medical bills and lost wages. Many workers get bonuses when they file a compensation claim. But about 5% of those compensation claims may be denied. In such a case, the injured employee is financially responsible for his medical treatment. You have a unique opportunity to appeal if your claim is denied.

Submission of appeals

You can issue an application for claims adjustment with the Workers’ Compensation Commission during this process. After that action, the WCC will assign a number and an arbitrator to your injury case. 

You can ask for a hearing with the arbitrator and the employer to get an explanation of the information. There you have a chance to get an instant exam and make your decision very quickly.

Then the commissioners will check the decision and set a date for the relevant hearing. You can also submit a clear document supporting your claim before that date. You will only get about 10 minutes to argue your case at the relevant hearing.

The most accessible and appropriate thing you can do here is to hire a lawyer. He will help you prepare for your trial and ensure that your claim is the best.

Take alternative opportunities

Even if you make appeals as above, there will be times when you’ll have to get stuck on the question of What happens to medical bills when workers’ comp is denied. There you can choose alternative scenarios. 

It is a great comfort to you. Insurance companies are not required to pay the cost of medical bills to injured workers. That means you don’t have to pay the treatment expenses out of your pocket. If an employee company denies your claim, they will be responsible for covering the bill.

Group health insurance

Group health insurers are very open about covering cumulative medical expenses. Accordingly, there is a great chance to solve the case of a more compact worker in a short time. Another factor that may be relevant is the group health insurance you have for your spouse. Most health insurance groups provide coverage to the insured in the event of a workers’ compensation lawsuit dispute.

Here you may have to file a dispute notice. And after signing a document like an indemnity agreement, your settlement is done. After receiving it, you must give your consent to the reimbursement to the insurance company. 

Get the help of a more experienced lawyer for this. Also, working with a workers’ comp attorney will minimize the amount you have to pay back if you receive compensation. For that, discuss with the group health insurance carrier.

Your health insurance

You can also use your health insurance as another trick. Most health insurance plans have deductibles. That means you won’t have to endure periods when you can’t work. If you still have the question about What happens to medical bills when workers’ compensation is denied using other options, you can use your health insurance.

If workers comp is denied, you will receive workers’ compensation. Then the insurance carrier is motivated to reclaim the money they paid to protect your medical charges. 

Medicaid and Medicare

Medicaid is the nation’s public health insurance program for low-income earners. To use Medicaid coverage, you must show that you were in a low-income bracket at the time of the injury.

The downside is that it doesn’t incur high fees. It means that the level of medical care you have access to is not high quality. These coverages are often free, premium, or not available with deductibles. Not all hospitals accept Medicaid.

And Medicare is your next option. They focus on several aspects. People aged 65 and above, young people with disabilities, people with end-stage kidney disease, etc., belong to this coverage.

The injured person must apply for Social Security Disability benefits to receive Medicare coverage. And he has to wait for 29 months from the date of the disability. Medicare coverage is unique to Medicaid coverage because most hospital-based medical providers accept it.

FAQ on workers’ compensations

What is the most accessible workers’ compensation claim to file?

The easiest and fastest type of claim to process is the medical one. Medical reimburses the injured worker for his medical expenses only. The injured worker can report to work again on the injury or the day after. Therefore, he does not need compensation for lost wages. It happens when the employee does not receive costly medical treatment. 

Who is required to provide workers’ comp coverage?

An employer is required to provide workers’ comp coverage. If you have to use a different type of expense to pay for your medical bills when you have a work-related injury, you have the option of calling a workers’ compensation attorney. It happens when the employer pressures you.

Who will pay the bills to the workers if the claim is disputed?

Imagine a situation where your employee commission entitlement is disputed. Then, you can pay the medical bills with your applicable group health insurance or your spouse’s group health insurance. The same is true when providing coverage for your immediate family member. However, if you receive workers’ compensation, you must agree to reimburse the insurance carrier for the amount they spent.


More articles

I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder. I am certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and by the Practice Management Institute (PMI) as a Certified Medical Office Manager (CMOM). As an office manager/biller/coder, I was a member of the Michigan Medical Group Managers, Michigan Medical Billers Association. I also served as a committee member of the Michigan Osteopathic Association of Practice Managers Education Committee.

Latest article