What Happens To Medical Bills When Workers Comp Is Denied? A Guide
You might be stressed if you got hurt at work and your workers’ compensation claim was denied. It’s even more concerning when you are facing medical bills after a workers’ comp denial. So, what happens to medical bills when workers’ comp is denied? Who pays medical bills while waiting on workers’ comp?
While you deal with your injury and the legal process, medical bills can pile up. This can put a strain on your finances and make you wonder, “How will my medical bills be paid?” In this article, we’ll explore what happens to medical bills when workers’ comp is denied, and what your options are. We will also cover frequently asked questions, such as “Can I use my personal injury protection if workers’ comp is denied?” and “Will my health insurance cover medical costs?”
Reasons Why a Workers’ Compensation Claim May Be Denied
Before we talk about what happens to your medical bills, it’s important to understand why some workers’ compensation claims are denied in the first place. Sometimes employers and insurance companies don’t follow what’s required by the workers compensation law.
Insurance companies are businesses, so they are concerned with their bottom line. They sometimes deny legitimate claims hoping that you’ll give up. This makes it crucial to understand your workers’ compensation coverage and your rights as an injured worker.
Here are some reasons your claim could be denied:
1. You Missed Reporting Deadlines
Every state has deadlines for reporting your work injury and for filing workers’ compensation claims. In North Carolina for example, you need to tell your employer within 30 days of the workplace injury. If you don’t meet this deadline, it could hurt your case. Missing other filing deadlines throughout the process could also result in denial.
2. The Insurance Company Disagrees With Your Doctor
The insurance company may require you to see a doctor they choose for an independent medical examination (IME). If this doctor says your injury isn’t work-related or is less serious than you claim, it could weaken your case. If your medical providers are not considered to be in your insurance company’s network, this could also be used as a reason for denial.
3. The Employer Disputes Your Claim
Your employer might argue that the injury is not work-related or happened when you were doing something outside of your normal job duties. They may also misclassify you as an independent contractor to avoid paying benefits, which impacts what happens to medical bills when workers’ comp is denied. Make sure you fully understand the terms of your employment to avoid issues if you are injured and need to seek compensation.
4. There Were Mistakes in Your Workers’ Comp Filing
Leaving out information, having inaccuracies in your accident description, or not having enough supporting documentation can hurt your case. It’s important to provide detailed and accurate information in your initial filing. Working with a compensation attorney can help you to avoid mistakes when filing.
What Happens to My Medical Bills After My Workers’ Comp Claim Is Denied?
If your workers’ comp gets denied, you’re probably wondering, “Now who pays my medical bills?” This is a major concern. Let’s explore the possible scenarios:
Scenario 1: You Pay Out of Pocket
This is the least desirable outcome, but if other options fail, you might be stuck paying medical bills out of pocket until the workers’ comp situation is sorted out. This can be incredibly stressful, especially if you’re out of work because of your injury and have to cover medical costs. It’s crucial to keep detailed records of all your expenses, including medical bills, travel costs, and any lost wages in case you are later able to recover those costs.
Scenario 2: Your Health Insurance Might Help (But You Could Have to Pay It Back)
If you have health insurance through your spouse or purchased independently, it may cover your treatment. However, they might require you to file a dispute notice and might seek reimbursement for what they paid if you later receive a workers’ compensation settlement or award. Whether you should use your health insurance or pay out of pocket is a discussion to have with your attorney.
Scenario 3: Explore Government Programs If You Qualify
If your injury leaves you unable to work for an extended time, government programs such as Medicare or Medicaid may be an option to help cover your medical costs while you’re unable to work. Keep in mind that qualifying for these programs depends on various factors such as income and disability status. Social Security disability benefits may also be an option if your injury is severe.
What Can You Do If Your Workers’ Comp Is Denied?
If your initial claim was denied, here are steps you can take:
1. File an Appeal
You have the right to appeal a workers’ comp denial. Your state will have a specific process for appeals, but it is important to file your appeal by the filing deadlines. It usually involves filing a petition for review and presenting your case before a workers’ compensation judge. Form LICB-2526 is used in Pennsylvania to file this appeal.
2. Gather Stronger Evidence
Your original claim may not have had enough evidence to convince the insurance company. Get your medical records in order, gather witness statements (if applicable), and clearly document your injuries, treatment plan, and how the injury impacts your ability to work. A compensation lawyer can help you to understand what evidence may be helpful to your claim.
3. Get Help From a Workers’ Comp Attorney
A lawyer experienced in workers’ compensation law can help you build a stronger case, navigate deadlines, understand your rights, and fight for the compensation you deserve. It can feel daunting to take on an insurance company on your own, and a lawyer who handles cases similar to yours regularly can be a huge asset. An Illinois workers’ compensation law attorney knows the intricacies specific to the state, but almost every state has experienced attorneys in this field.
What Can Happen If You Don’t Pay Denied Medical Bills?
Ignoring medical bills never makes things better. While it’s stressful when workers’ comp denies your claim and leaves you responsible for payments, there can be consequences for non-payment:
- Damage to Your Credit Score: Unpaid medical bills can negatively impact your credit score, which can affect your ability to rent an apartment, secure a loan, or even get a job.
- Collections Agencies: Medical providers often send unpaid bills to collections agencies. Dealing with collection agencies adds stress and could mean additional fees and penalties.
Key Takeaways: Medical Bills When Workers’ Comp is Denied
Dealing with what happens to medical bills when workers’ comp is denied is stressful. But you have options. Don’t lose hope if you find yourself dealing with a denied claim. While it can be disheartening to face a denied workers’ compensation claim, understanding your options is essential for protecting yourself and ensuring that you get appropriate treatment.
Conclusion
Navigating workers’ compensation claims, especially when they’re denied, is complex. But knowing what happens to medical bills when workers’ comp is denied can help you make more informed decisions during a challenging time. Remember to consult with a workers’ comp lawyer to determine the best options for you based on your circumstances. Contact SSLG today for a free case evaluation.
The information provided in this blog article is intended to be general in nature and should not be construed as legal advice. Social Security laws and regulations are subject to, and often change. Please consult the official Social Security Administration (SSA) website or contact SSLG for advice regarding your specific legal matters.