Which Medical Expenses Are Covered By Workers Compensation?

An injured employee should receive medical treatment for their injury whether or not their workers compensation claim is accepted.

If someone becomes injured or ill at the workplace, they are entitled to receive benefits under workers compensation. The employer or the insurance company will pay for the medical expenses arising out of the work-related injury. Depending on the severity of the injuries and the inability of the employee to go back to work, the worker may also receive disability benefits.

All Medical Expenses Related to the Injury

Missouri workers compensation attorneys inform us that an injured employee will receive medical benefits for the work-related injury even if they are still to file for a workers compensation claim. They will be given medical treatment for the injuries irrespective of whether or not their claim is accepted. An employee should understand that all medical expenses related to the injury, including the cost of diagnostic tests, emergency room charges, hospitalization charges, doctor visits, and other miscellaneous costs are covered by workers compensation. Employees can also claim the cost of traveling to the hospital for receiving medical treatment for the work-related injuries.

Quite often, injured workers are doubtful about whether the cost of diagnostic tests is covered under workers compensation. Diagnostic tests such as MRI, x-ray, or ultrasound that are conducted to evaluate the injury are covered under workers compensation.

The Costs of Alternative Treatments

Another common confusion is regarding the cost of alternative treatment. Everyone knows that standard treatment practices such as medication and even physiotherapy are covered by workers compensation, but are alternative treatment practices covered? Alternative treatments such as acupuncture or naturopathic treatment are not covered by workers compensation.

However, if the injured worker is willing to pay from his pocket for such treatments he can do it, and get the treatment. However, he will not be able to make a claim for this treatment. Physiotherapy, massage therapy, and chiropractic treatment may be covered under workers compensation, but there might be a restriction on the number of treatments you can receive.

Workers compensation may also cover surgery costs, if it is the only effective treatment available for the injury or illness. However, it will be approved only if other lines of treatment have been tried and have been found to be ineffective.

When the Medical Bills Will Be Paid

Many workers would like to know as to when will the medical bills be paid. According to Missouri workers compensation lawyer, the employer or the insurance company will pay the medical bills immediately, and continue to do so for the time period for which your claim is open.

To receive medical treatment for the work-related injury the worker needs to notify the injury to the employer and he can immediately start receiving medical treatment from the doctor designated by the employer’s insurance company. If at any point, the injured employee feels that he is not getting appropriate treatment or his bills are not being paid, he should immediately consult with The Law Office of James M. Hoffmann at (314) 361-4300.

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Have you been injured in an accident?
Call (314) 361-4300.
Free Missouri Workers’ Compensation Consultation!

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Why Following the Doctor’s Orders is Vital for Your St. Louis Workers Comp Case

Once you claim workers’ compensation, you have an obligation to seek the proper medical care to make your injuries better.

If you are hurt at work, then you are likely eligible to have your medical costs and lost wages covered by workers’ compensation insurance. In the state of Missouri, any company that has employees must be insured by workers’ compensation insurance in order to cover any workers who are injured while they are engaged in their work-related activities. If you are hurt at work, regardless of whose fault it is, your medical costs and any money that you lost due to being out of work are compensated for under workers’ comp.

What are Your Obligations?

Workers’ compensation differs from personal injury in that it doesn’t matter who is at fault for the injuries. The worker can be wholly responsible for their injuries and still be entitled to gain coverage to get back to work. But that does not mean that the employee does not bear any responsibility for their injuries.

Once you claim workers’ compensation, you have an obligation to seek the proper medical care to make your injuries better and to document not only how they happened, but the extent of your injuries. The insurance company will want proof that the injury was sustained while engaged in work-related activity, how long your injury will take to heal, and also that you were injured in the first place. The only way to prove those facts is to seek medical attention immediately when you have been hurt.

Responsibility to Mitigate Your Injuries

If you are eligible for workers’ compensation benefits and are receiving them, then you do have an obligation to mitigate those injuries. This means that you have to make every effort to make your injuries better. In the same respect, you have a responsibility not to make them any worse. So if you skip an appointment, don’t follow your doctor’s orders, or refuse treatment that will ameliorate your injuries, then you may be giving the workers’ compensation insurance company cause to either stop your payments or to deny your claim. 

What if Surgery is Recommended?

Although surgery can come with risks, if surgery is recommended and it will help to make your injury better and return you to the full capacity you had before you were injured, then the insurance company might be able to insist that you have surgery or deny you coverage going forward. Since workers’ compensation is based around the notion that it is there to help a worker heal and get back to work, having a treatment that would aid the worker to return them to full capacity may be required.

If You Don’t Want to Have Surgery

If you are worried about surgery and there is a chance that it might not make you better, then you have to decide for yourself what it best. If you are fearful that the surgery might make things worse or the success rate is not very good, then it is important to hire a St. Louis workers’ compensation attorney to plead your case if your benefits should be withheld due to failure to mitigate your injuries. They can help you with an appeal if you are denied coverage.

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Gathering Medical Evidence for Your Workers’ Compensation Claim

In order for an injured employee to be fully compensated for their work-related injury, the medical evidence must be documented accurately.

When an employee is injured while on the job, the employer’s workers’ compensation insurance is there to cover the cost of all medical care and lost wages that are a result of the injury. This is designed to protect the employee from having to pay for medical care out-of-pocket and to protect the employer from any legal action being taken against them.

Are the Expenses Relevant to the Work-Related Injury?

In order for the employee to ensure that they are compensated for all of the medical bills that are accumulated, it is up to the employee to make sure that the expenses are relevant to the work-related injury and that they are accompanied by an affidavit signed by the treating physician. The absence of such documentation could cost you the compensation you deserve. If you have any doubt about the medical evidence you have retained or if your employer is questioning the bills you have submitted as evidence, a Missouri workers’ compensation attorney can help. Bring your documentation to The Law Office of James M. Hoffmann to be evaluated and to find out what you need to do in order to be compensated for all of your medical expenses.

Documenting Out-of-Pocket Expenses

During the course of your treatment, you may have to pay some out-of-pocket expenses. These might include insurance co-pays for medical care or pharmacy bills for medications. It is important that you are given detailed receipts for these expenses and when applicable, have the physician sign a paper that states the relevancy of the bill to your work-related illness or injury. The absence of such paperwork could nullify the medical bill or expense.

Case Study – Medical Bills Disputed by the Employer

A Missouri employee who suffered from a work-related lower back injury faced such a problem when trying to recover all of the monies he had lost as a result of the injury. While the employer did not dispute that the injury was a direct result of his job or that they were responsible for the medical bills, they did dispute the validity of some of the medical bills that were presented as evidence.

The workers’ compensation board, who heard the case on appeal filed by the employer, agreed and determined that certain bills submitted as evidence were to ambiguous to be considered real evidence and did not include them in the reward for compensation of medical expenses. The flaws that stood out was the absence of any additional proof, either by direct testimony or affidavit, that these bills were in any way related to the accident. Also questioned were obvious marks that were meant to obliterate parts of the bill.

Missouri Workers’ Compensation Attorney

How you present your evidence in a workers’ compensation appeal is extremely important. These types of cases are reliant on medical evidence in order for you to be completely compensated. Having that evidence, but not presented properly, will cost you the right to reclaim your losses.

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