Recovering Medical Bills

When you suffer an injury at work, one of your first concerns might be how to pay for treatment. Fortunately, Pennsylvania worker's compensation insurance will usually for all "reasonable and necessary" treatment for that injury. However, there are some complicated legal issues that may arise in establishing that your medical treatment is relevant for your work injury. It is a good idea to have an attorney who can navigate these issues for you.

What medical expenses count as work-injury-related?
Workers compensation insurance will cover all "reasonable and necessary" expenses relating to your work injury. This includes the cost of doctor's visits, surgery, hospitalization, medication, and medical devices - as long as they relate to your specific work injury.

Will workers compensation help me with medical bills that do not relate to my work injury?
Generally speaking, no.

How do I establish that my medical expenses are related to my work injury?
Once your injury claim is accepted, that injury will be described in your Notice of Compensation Payable (NCP) or Notice of Temporary Compensation Payable (NTCP). Workers compensation is only required to pay for treatment that is related to that specific injury and the particular region of the body that has been injured. However, injuries often grow worse over time or begin to cause other symptoms in other parts of the body. If that happens, you can file a petition to correct or expand the original description of injury, which will allow you to have treatment for these new symptoms or diagnoses.

Insurance companies usually try to minimize the extent of your compensable injury. The NCP or NTCP that your employer files might describe the injury as something narrow and specific; that way, they can later claim that other symptoms or diagnoses are not related to the work injury. It is helpful to have an attorney who will fight to amend the description of your injury if applicable, so that you can receive medical coverage for symptoms that arise later.

Will workers compensation pay for medical bills at any medical establishment I choose?
It depends. After you have notified your employer about your injury, you may be required to seek treatment for a panel doctor for the first ninety days. If your employer has provided you with a list of panel doctors following your work-related injury, they are generally only required to pay for treatment with one of those panel physicians for those first 90 days. If during those 90 days, you seek treatment from a doctor who is not on that list, workers compensation is usually not required to pay. However, if your company does not have or does not provide you with a list of panel doctors, you may go to your own choice of doctor immediately. After the first 90 days, you may seek treatment with a doctor of your choice, and workers compensation is required to cover the costs as long as that treatment is reasonable, necessary, and related to your work injury.

If my employer contests my claim, who will pay for my medical bills in the meantime?
You may obtain payment by a regular health insurance provider or bills on your own. If you win your case, there usually will be reimbursement and/or a lien, meaning the workers compensation insurance carrier will have to pay back all or some of the bills to you or to that health insurance provider.

How long will workers compensation continue to pay for my medical bills?
Your insurance carrier is required to pay for your treatment as long as you have an open claim and that treatment are reasonable, necessary, and causally related to that injury. There is no set time limit on how long they must continue paying, however, your employer may at any time file a petition to determine whether that treatments meets the criteria listed above. Workers compensation may also stop paying medical bills once you have reached a settlement.

Once my claim has been accepted, are there circumstances in which my insurance company can refuse to pay work-related medical bills?
If you workers compensation insurance carrier suspects that you are recovered enough that you no longer require continuing treatment, they can file a petition to terminate workers compensation benefits, including payment of medical bills. They can also file for a Utilization Review and request all treatment records from your medical provider. The Utilization Review Organization will then determine whether your treatment has been reasonable and necessary. If they find that some or all of your treatment is either unreasonable or unnecessary, they will not be required to pay those bills, but you can still appeal the decision before a worker's compensation judge.

It can sometimes be difficult to determine whether and for how long the workers compensation insurance carrier is required to pay medical bills. Our experienced attorneys would be happen to answer any questions and discuss with you whether particular bills would be covered.

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