What If Workers Comp Doesn’t Cover My Medical Costs?

If you are injured at work and file for workers compensation, the expectation is that medical costs will be covered. However, depending on several circumstances, that is not always the case. Finding out the reasoning behind lack of coverage and knowing what to do at that point is imperative if you feel your claim should still stand. It is also imperative to know prevention methods in the future should you ever need to file again.

Potential Reasons Medical Costs Are Not Covered

There are a variety of reasons your medical costs may not be covered under your workers compensation claim. Did you notify your employer ASAP of the situation and injury? Did you file the claim within the statutory time period required? Did your injury occur within your place of employment and was it related to your specific job? Were you completely sober (not under the influence of alcohol or drugs)? If you answered “no” to any of these questions, you may have found a reason your costs are not covered.

Also for consideration is whether or not you had a pre-existing condition prior to the incident or whether or not the injury is actually a serious one. You may want to ask yourself if medical treatment is “reasonable and necessary.”

Unfortunately, in some cases it is even possible that your employer has disputed your claim and is withholding the truth.

What To Do Going Forward

If your costs were not covered, a few options are available to you.

  • Use your own health insurance. Most insurance companies will pay disputed bills provided that you sign an agreement to reimburse them if you win your workers compensation case.
  • Make sure you are visiting the correct provider. Not all providers are covered under workers comp and switching providers may solve the problem.
  • You may appeal your denial. Be prepared to present medical evidence at the hearing.
  • Talk with an experienced workers compensation attorney about your claim.

Prevention Methods

To ensure your medical costs are covered under workers comp, make sure to document all injuries (with pictures if applicable) ASAP. Make note of your injury and pain on ALL intake forms and make sure your doctor is aware to do the same. Be specific and always review paperwork thoroughly. If you are still unsure of what to do, contact us to schedule a consultation.

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Van Camp, Meacham & Newman, PLLC
2 Regional Circle
Pinehurst, NC 28374