Accidents in the workplace are an unfortunate occurrence but surprisingly common.
Accidents might be even more common depending on your type of employment, but they can happen to anyone. When accidents happen at work resulting in an injury, most workers rely on workers’ compensation to pay their medical bills and replace lost income. Depending on your injury, you could be looking at tens of thousands of dollars in medical bills and lost income.
However, depending on where you live and the nature of your injury, worker’s compensation may deny your compensation claim. A denied compensation claim could leave you in financial trouble if you don’t have good health insurance.
If you’re wondering what happens to medical bills when workers comp gets denied, you’ve come to the right place. This article will look at possible reasons for denial, whether or not you have additional options, and what your next steps should be.
- Why Workers’ Compensation Claim Can be Denied
- If Workers’ Compensation Denies Your Claim, You Still Have Options
- How to File an Appeal for a Denied Workers’ Comp Claim
- Use Other Health Insurance to Pay Medical Bills – But Be Careful
- FAQs on Medical Bills and Denied Workers’ Compensation Claims
- Don’t Give Up if Worker’s Compensation Denies Your Claim
Why Workers’ Compensation Claim Can be Denied
Worker’s compensation is a compulsory program designed to help employees injured in the workplace. Workers’ comp covers almost all employees, however, states have differing exclusions. If the injury is severe enough to result in medical bills or you must miss work time, the worker’s comp will get involved.
Because of how worker’s compensation works, there are many instances when compensation claims get denied, such as:
- If the accident didn’t happen at work or while you were doing something related to work
- You took too long to notify your employer about the injury
- The injuries you claim to have sustained are preexisting
- You were under the influence of drugs or alcohol at the time of the incident
- The injury wasn’t severe enough to justify taking time off work
- Workers’ comp is not paying medical bills because you didn’t go to an approved provider
- You aren’t listed as a beneficiary in your employer’s policy
- You couldn’t prove the injury happened at work or didn’t provide enough information
Workers’ comp can deny treatment for these reasons and more. You must follow the rules and regulations of your state down to a T and act fast when you suffer an injury in the workplace.
If Workers’ Compensation Denies Your Claim, You Still Have Options
If the workers’ comp denied medical treatment because they didn’t accept your compensation claim, you still have options. While you are now responsible for paying your medical bills, there are many ways that you can go about it. So, before getting alarmed or stressed about your high medical bills and lost income, take some time to examine these options.
File a Claim Adjustment Application
After a denied compensation claim, the first step is to file a claim adjustment application with your state’s Workers’ Compensation Commission (WCC). You typically have a year or two depending on the state to file your appeal, however, the sooner the better.
Request a Hearing
After filing your claim adjustment application, you will request a hearing with an arbitrator from the WCC depending on your state’s rules and regulations. You will then have the opportunity to meet with the arbitrator and argue your case in person. Remember that your medical bills are likely piling up by this time, so the sooner you act, the better. Because of the time sensitivity of your case, it might be a good idea to have a healthcare advocate or lawyer by your side.
Try Filing an Appeal
If the arbitrator doesn’t rule in your favor and denies your compensation claim or if you’ve bypassed this step depending on your state’s rules, your last chance is to file an appeal directly with the WCC. You’ll have 30 days to do this following the arbitrator’s decision, and your appeal will occur in front of three WCC commissioners.
Once again, having a lawyer or healthcare advocate at your side is a good idea to prepare you and help you argue your case. Keep in mind, however, that the attorneys are typically awarded 20% depending on the state of your unpaid disability benefits if he or she wins the appeal.
How to File an Appeal for a Denied Workers’ Comp Claim
If you’re forced to file an appeal for a denied compensation claim, you should contact us at Amazing Healthcare Consultants. Filing an appeal is complicated and time-sensitive, and it’s best to have a team of pros on your side who know what they’re doing. You’ll have two to four weeks to file your claim depending on where you live, and only five to ten minutes to argue your appeal when the time comes.
Use Other Health Insurance to Pay Medical Bills – But Be Careful
If worse comes to worst and you have to pay your medical bills, you have several health insurance options.
However, you must be careful if you decide to do this because using alternative health insurance to pay medical bills amid a worker’s compensation claim could have ramifications.
The main one is that they may require you to agree to subrogation should you be awarded workers’ comp in the future as well as the possible out-of-pocket costs. For that reason, you should contact a healthcare advocate before going down this road.
You Can Use Your Health Insurance Plan
Your first option after a denied worker’s compensation claim is to use your own health insurance. While this isn’t ideal, it’s better than getting saddled with thousands of dollars in medical bills. However, you should only rely on your own insurance after you’ve exhausted all other avenues.
You Can Use Medicaid if You Meet the Criteria
Applying for Medicaid is another excellent option if you don’t have health insurance and meet Medicaid’s criteria. Medicaid is federally funded, but each state has the right to make its own rules and regulations. Therefore, make sure to check the requirements for your state before trying to apply for Medicaid.
Another possible issue with Medicaid is that it isn’t accepted by all hospitals and healthcare providers. This means you might have to spend extra time looking for the right provider, and not everyone has the luxury of time.
You Can Use Medicare if You’re Eligible
As with Medicaid, Medicare is a federal program. In general, however, you have to be over 65 years old or have ESRD, or be disabled. It’s easier to find a healthcare provider that accepts Medicare, but the criteria are stricter.
FAQs on Medical Bills and Denied Workers’ Compensation Claims
Don’t Give Up if Worker’s Compensation Denies Your Claim
If your worker’s compensation claim gets denied, the best thing you can do is contact us at Amazing Healthcare Consultants. One of our many areas of specialty is helping people who have had their compensation claims denied. We can help you file appeals, fill out applications and forms, and devise a plan to make things right. The key is never to give up and keep pushing until justice is served.