After having your Michigan workers’ comp claim approved, all reasonable and necessary medical bills related to your work injury should be paid for in full. So what can you do if your employer’s insurance carrier refuses to pay for your surgery or any other treatment that your physician says you need?
Jay Trucks explains more about the medical benefits provided under workers’ comp, including what you can do if your insurance carrier denies payment for any of your medical treatments.
If payment has been delayed or denied for reasonable medical care you received for a work injury, we may be able to help. Contact our workers’ comp attorneys in Grand Rapids to schedule a free consultation today to learn more.
What Medical Care Should Workers’ Comp Cover?
According to Michigan’s Department of Labor and Economic Opportunity, workers’ comp should pay for all of an eligible employee’s reasonable and necessary medical care. Additionally, the bills related to your work injury should be sent directly to your employer – or his or her insurance carrier.
Costs covered by workers’ comp medical benefits may include:
- Emergency transportation
- Surgeries that may be required to aid in a worker’s recovery
- Medical appointments and examinations related to the injury
- Diagnostic testing, such as MRIs or X-rays that may be needed
- Hospital stays after a surgery or other related treatments
- Pharmaceutical needs, such as prescription medications
- Dental services that are related to the work injury
- Chiropractic care
- Crutches, wheelchairs and other mobility devices
- Physical therapy
What if Workers’ Comp Refuses to Pay for Care I Need?
It is not uncommon for employers and/or their insurance carriers to initially deny payment for certain medical costs for an injured worker. For example, say that you have a back injury that was reinjured on the job. The insurance carrier may refuse to pay for the treatment you need, saying the injury was preexisting. However, it can happen later on in your recovery as well.
Regardless of when your insurance carrier denied payment for your treatment, you may still have legal options for continuing your care. Some steps you can take to overturn the insurance carrier’s decision include:
- Contacting your insurance carrier and asking them to send you a written explanation as to why the payment was denied (if not included in the notice you received)
- Filing a dispute by submitting an Application for Mediation or Hearing form
- Continuing your medical care – while your claim is in dispute, you can submit your medical bills to your health insurance carrier
- Saving the invoices, receipts and costs related to the medical care for your work injury
- Carefully – and regularly – documenting the progress of your injuries
- Proactively discussing your injuries with your doctor
- Contacting a qualified workers’ compensation lawyer for legal help
The whole process of trying to appeal denied payment for the medical care you need can be frustrating and overwhelming, especially if you are trying to focus on your recovery.
Having an attorney to handle your claim and protect your rights can help to ensure you get the compensation you need faster. We are well-versed in state laws for workers’ compensation, and we are ready to work tirelessly on your behalf.
Why Did Workers’ Comp Deny Payment for My Medical Treatment?
Workers’ compensation should pay for all medical costs that are related to your work injury and are also both reasonable and necessary. However, even if your treating physician recommends certain medical care, the insurance carrier may disagree. They could refuse to pay for that treatment if they determine:
- The treatment is not deemed as either reasonable or necessary: Your insurer may argue that other treatments – cheaper or less invasive – could have been tried first.
- You have failed to follow your doctor’s orders: Consistently missing doctor’s appointments or failing to adhere to his or her care recommendations.
- Your injury or medical condition was preexisting: Commonly, insurers may try to argue that if your injury was preexisting, it could not be work-related.
- You have reached maximum medical improvement (MMI): Your insurer will likely deny payment for continued medical care if they determine you have reached your MMI.
Insurance carriers often try to get out of paying for medical costs. They may hope that once they deny your claim you will just give up trying to get your medical bills paid.
Is Workers’ Comp Refusing to Pay For Medical Care You Need?
At Jay Trucks, we understand how important it is for you to get the medical treatment you need after suffering a work-related injury. Our qualified attorneys have been handling workers’ comp cases for decades. We have recovered millions for our clients, including $480,000 for a pipefitter who suffered a severe close head injury in a work accident.
Get legal help you can trust when you call our firm. We are available to take your call 24/7, but deadlines may apply, so call today. If we find you have a case and you hire our services, there is nothing to pay up front. We do not get paid unless we recover compensation for you.
