Getting injured at work is stressful enough, but filing for workers’ compensation benefits and getting denied can feel like an extra gut punch.
Even if you just filed your claim, your mind has probably gone on a loop and you’re thinking about different worst-case scenarios. One of those intrusive thoughts must have also been what happens to medical bills when workers’ comp is denied.
While this sounds scary, there’s no need to lose sleep over it. There are options available to you.
We’re going to explore what happens to medical bills when workers’ comp is denied and the alternatives to workers’ comp benefits that can help you cover your treatment. However, the first item on the bill is the workers’ comp, and why your claim could get denied in the first place.
The reason why your claim could get denied
Workers’ compensation is a safety net for individuals who experienced a severe workplace injury that left them unable to complete their work duties. In short, if your injury is severe enough to eliminate your earning power, you are eligible for workers’ compensation wage loss benefits.
The most common reason these claims get denied is that, for instance, the injuries have no connection to your work activities. The injuries might have occurred earlier, or they simply weren’t serious enough to warrant medical treatment, or they don’t jeopardize your ability to complete your work duties.
Lastly, claims can also get denied if they don’t contain the necessary information regarding your injuries.
It’s important to note that some injuries may be non-compensable, and the events surrounding your injury matter. For instance, an insurance company may decline your benefits if you weren’t clocked in when the injury occurred. The same thing can happen if you were engaged in personal affairs when you got injured, or if your injury was caused by your reckless behavior.
Workers’ comp won’t cover your injuries if you were committing a crime when the injury happened. Furthermore, if you failed to report the event on time or if your injuries were self-inflicted, workers’ comp might deny your claim.
Most importantly, for a successful claim, there must be witnesses to your workplace accident.
If you somehow get denied, we suggest that you don’t give up yet. While there are other solutions, you should only entertain them in the worst-case scenario.
What to do if your claim is denied
If workers’ comp denied your claim, not all is lost. So to answer the question of what happens to medical bills when workers comp’ is denied, you can still get your benefits if you’re familiar with the appeals process.
First, you can apply for claim adjustment with the Workers’ Compensation Commission (WCC). After that, the WCC will assign an arbitrator and a number to your injury case. You can request a hearing to discuss the details with your employer with the arbitrator present.
We recommend you ask for a hearing with a request for an immediate hearing to receive your decision as soon as possible (usually within 180 days).
In case the arbitrator still decides to stick with the original decision of denying your claim, it’s not over yet. You can try to appeal this decision by filing a petition for review within 30 days of getting denied by the arbitrator.
After closely examining the decision, the commissioners will set a date for the hearing. Before this date, you may submit a document that contains the written argument that supports your claim. When arguing your case at the hearing, you get as much as ten minutes.
This entire process will go a lot smoother if you hire a lawyer. A legal professional can help you prepare for the hearing and ensure that your claim is as strong as can be. A lawyer can help keep things fair since you won’t have to face the entire process yourself. Your employer will most likely have an attorney present, and there’s no reason why you should show up alone.
If things don’t go as well as expected, you might feel defeated as the question of what happens to medical bills when workers’ comp is denied is still in the air. Worry not, as alternative options do exist.
While insurance companies are not required to pay for the cost of medical bills for workers who got injured, they do have to cover the bills in case a workers’ comp denies your claim. This means you won’t need to pay treatment expenses out of your own pocket.
You have a few options available:
1. Group/personal health insurance
Group or personal health insurers are open to covering the accumulated medical expenses while your workers’ comp case remains unresolved. The same applies to your spouse’s group health insurance.
However, there are a few things you need to be aware of. You’ll have to file a dispute notice, and you will most likely have to give your consent to pay back the insurance company after receiving your settlement by signing a document known as a reimbursement agreement.
An experienced lawyer can help negotiate a lower amount you have to repay with the insurance company and possibly help you receive a fair workers’ comp settlement.
2. Medicaid and Medicare
If you don’t have a group or personal health insurance, Medicaid might settle your medical bills. However, it only applies to low-earning power workers with limited personal assets.
While Medicaid is better than paying out of pocket, there are some drawbacks. For example, the program is notorious for its low rates, which means you’ll have to settle for treatment of lower quality. A great number of medical providers also don’t accept Medicaid, so you’ll have to spend extra time looking for a provider.
With Medicare, on the other hand, it’s a lot easier to find a provider. However, the criteria to become eligible for this program are more strict. If you’re at least 65 years old, you’re eligible. But if you don’t meet the age requirement, you can receive Medicare only if you’re approved for disability benefits from social security.
Keep in mind that Medicare is only available 29 months after the injury.
Navigating the workers’ comp maze
Hopefully, this answers your question of what happens to medical bills when workers’ comp is denied. The path ahead of you isn’t easy, and navigating the workers’ comp maze alone would be overkill (especially considering that you’re already under a lot of stress).
Our advice is to hire an experienced lawyer from the onset of your claims process.
Not only will you feel more comfortable knowing you’ve got someone on your side explaining your rights and options, but the results will most likely be better. You’ll not only have someone representing you at the hearing, but you’ll walk away with the best possible settlement.