That’s right, your employer’s worker’s compensation insurance pays all of your medical bills & treatment for a work-related injury. However, the incident at work must be the prevailing factor. The prevailing factor is the main cause, that is, 51% of the cause of your injury. You fell off the ladder in the warehouse and broke your leg. The fall is the prevailing factor in causing your broken leg.
Your bills for emergency treatment are covered in full no matter where the ambulance takes you. This is because in an emergency, there is no time to check what hospital is covered under your employer’s work comp insurance. Consequently the ambulance, hospital, doctor & medications are covered by worker’s compensation insurance. Your health insurance won’t pay those bills. You should not pay any ambulance, hospital or emergency room doctor bill. This includes medical bills for x-rays, MRI or C-T scans. You don’t have to pay for filling prescriptions from the emergency department doctor’s orders. Also you do not have to pay for any crutches, elastic wraps, wheelchair or similar items the doctor prescribes. This means:
- no deductible
- no copay
FOLLOW UP VISITS:
Follow up visits as prescribed by the emergency department doctor, including any referrals to a specialist are covered under worker’s compensation. However, you need approval from the worker’s compensation insurance adjuster. Why? Because the deal is, if they are paying for your treatment, they get to choose who your doctor or physical therapist will be. The doctor will not treat your work injury until the work comp insurer approves payment in advance. Some employers will assign you a case manager. Usually this is a nurse, but it can be an insurance adjuster. These people can be helpful, however, you are not required to allow them into the treatment room with your doctor. After your examination, it is appropriate to meet in the doctor’s office, allowing the case manager to hear the doctor’s treatment plan for you.
CAN’T I GET A SECOND OPINION?
Sure, you may request a second opinion. Usually, the employer will not pay for one. Sometimes a doctor will see you for a second opinion. This mostly occurs when the employer requests one. So, you may see the doctor of your choice, BUT, you will have to pay the medical bills & treatment for it if worker’s compensation does not approve. And, if you try and see a doctor under your health insurance plan, as soon as you tell the nurse you were injured at work, health insurance will not pay. Most health insurers will not pay for a work-related injury.
For more info check out my post “When Worker’s Comp Doesn’t Pay“.