If you are injured on the job, you usually rely on workers’ compensation to pay the bills as you recover. But what happens if your workers’ comp claim is denied? You still have expenses, and your medical bills may be piling up. Medical costs often rapidly escalate beyond what anyone would have reasonably saved. What happens to medical bills when workers’ comp is denied? Do you have to pay them yourself?
Thankfully, while a dispute is pending, your insurance usually covers your bills. How much you must pay after a dispute ends depends on your insurance coverage and whether you can successfully appeal.
Having an experienced attorney to guide you through the process is invaluable. At Gerling Law, our lawyers are ready to help you with your next steps. Work injuries already limit your earning capacity and send you on a stressful road to recovery. A workers’ comp denial can leave you feeling weighed down by a flood of medical bills. Contact an attorney to remove some of the pressure and help you regain your life.
How Does Workers’ Compensation Work?
Generally, to qualify for workers’ compensation, you need to:
- Have a job that provides workers’ comp coverage;
- Be injured;
- While working;
- Not be at fault for your injury; and
- File a claim on time.
Most workers’ comp denials happen because of failure to satisfy one of the above conditions. Nearly all employers are legally required to provide workers’ compensation coverage, with limited exceptions.
However, you are generally entitled to compensation when your injury is covered. So, what does compensation include? Does workers’ comp cover medical bills? What about other injury-related losses?
Workers’ comp usually covers medical bills and any rehabilitation costs related to your injury. It also pays an amount equal to two-thirds of your average weekly wage. How long you may continue to receive compensation depends on when and whether you can return to work.
What Can You Do If You Are Denied Workers’ Compensation?
If your claim is denied or you are having issues with workers’ comp not paying medical bills, do not panic. You have options, including informal dispute resolution and appealing to the Workers’ Compensation Board (WCB). If you successfully dispute or settle the issue, your benefits will generally be backdated.
Disputing Issues with a Claim
You can file a Request For Assistance with the WCB to begin informal dispute resolution. Sometimes, you can convince the workers’ comp insurance company to reverse or even avoid a denial through this informal process.
If your issues remain unresolved, you can request a hearing with a member of the WCB. To do so, you file an Application for Adjustment of Claim within two years of the injury date. At the hearing, you present evidence that your injury should be covered. Then, the board member determines whether and how much compensation you should be awarded.
Appealing
If you or the insurance company is dissatisfied, you can appeal to the full WCB by filing an Application for Review by Full Board. If either party is still dissatisfied with the WCB’s ruling, you can appeal to the Indiana Court of Appeals and, finally, the Supreme Court of Indiana.
Who Pays Workers’ Comp Medical Bills When a Claim Is Denied?
So you understand that you can appeal, and if you win on appeal, workers’ compensation will generally cover your medical bills. But appeal can take a long time. Or you can choose not to appeal. What happens then?
Paying Bills If You Do Not Have Health Insurance
You might have to cover your bills yourself if you do not have health insurance. However, many hospitals and treatment centers have programs to assist those who do not have insurance. If you win a dispute, you or the treatment center may be refunded for your expenses.
Paying Bills During Disputes
As long as you have health insurance, it will generally cover the bills you receive while a dispute is pending. However, your insurance company will likely expect to be reimbursed by the workers’ comp insurance company if the dispute is resolved in your favor. The reimbursement often comes out of your settlement or award.
Paying Bills If You Get a Final Denial
Your health insurance company will generally cover bills consistent with your policy if your claim is ultimately denied. Unfortunately, this might result in high out-of-pocket expenses.
Additionally, health insurance companies do not want to pay for services that workers’ comp should cover. If you give up on a claim and your health insurance disagrees with your choice, you can find yourself at the center of a complicated dispute between two insurance companies, where no one wants to be.
Do Not Panic—Contact Gerling Law
Disputing or appealing a denial of workers’ compensation can seem daunting despite how much money it could save you. Contact an attorney at Gerling Law as soon as possible for a free consultation if your workers’ comp claim was denied. Time is of the essence—not just because you only have two years to dispute a claim, but because the longer you wait, the more your stress levels will rise.
