What Happens to Medical Bills When Workers’ Comp Is Denied?

If you’ve suffered a serious injury at work, you might be counting on workers’ compensation to pay your medical bills. But what happens when workers’ comp is denied?

You’ll be on the hook for your medical bills following a rejected claim. However, if you file a successful appeal, your employer’s workers’ compensation insurance will be responsible for covering the cost of your care.

If you’ve recently had a workers’ compensation claim denied, don’t panic — you might still be able to get your medical care covered. Here’s a closer look at what to do next.

Why Does Workers’ Comp Deny Claims?

The first step is to determine why your claim was rejected. Here are a few possible reasons for the denial:

• You didn’t notify your employer of the injury in time.
• You didn’t file a workers’ compensation claim in time.
• You didn’t seek medical treatment for your injury.
• Your injury happened outside of work.
• Your injury happened when you were under the influence of drugs or alcohol.
• You sought treatment from a doctor not approved by your employer.
• Your injury arose due to a pre-existing condition.
• Your injury was the result of horseplay or roughhousing.

You should receive a letter that clearly states the reason for the decision. If the reason is unclear, reach out to the insurer for clarification.

Does a Workers’ Comp Claim Denial End Your Right to Medical Coverage?

Receiving a workers’ compensation claim denial can be discouraging, but it’s not the end of the line. You may still be able to receive medical benefits by filing an appeal.

The appeals process can be time-consuming and labor-intensive, but it’s far better than being stuck with all the medical bills from your injury. While you aren’t required to work with a workers’ compensation attorney, the Pond Lehocky Giordano team understands what kind of evidence you need to improve your chances of approval.

Who Pays the Medical Bills After the Denial of a Workers’ Compensation Claim?

In most cases, you seek medical care for your work injury before your claim is finalized. If your claim is denied, your past, current, and future medical bills will still need to be paid.

When this happens, the responsibility for paying your medical expenses falls on you. That doesn’t necessarily mean you’ll be stuck paying out of pocket, though. Here are a few potential options for payment.

Can You Be Reimbursed for Out-of-Pocket Medical Costs?

If your workers’ compensation claim is initially denied but you ultimately win your appeal, you can be reimbursed for out-of-pocket medical expenses.

Make sure to keep track of all receipts related to medical appointments, medications, and other injury-related costs. You may also be repaid for mileage or other costs of transportation to your medical appointments.

During this period, you may be able to have your medical care covered through your private health insurance. Ordinarily, health insurance won’t cover costs related to work injuries. However, if your employer’s workers’ compensation insurance denies your claim, your insurance must typically cover your injuries.

Eligibility for Medicare to Pay Workers’ Comp

If you don’t have health insurance, you should check to see if you meet the qualifications for Medicare coverage. You might qualify for Medicare if you’re over 65 or have a qualifying disability or health condition.

Like private insurance, Medicare generally must cover your treatment if workers’ compensation doesn’t.

Eligibility for Medicaid to Pay Workers’ Comp

If you don’t have private health insurance and don’t qualify for Medicare, you might qualify for Medicaid. While Medicaid is a federal program, it’s administered at the state level. Each state sets specific eligibility criteria, but your income generally must be below a certain threshold.

How to Appeal a Denied Workers’ Comp Claim

If your employer’s insurance company denies your claim, you have the right to appeal the decision. Your denial letter should include the appeal deadline. This is something to pay close attention to because if you miss the deadline, you may lose your chance to appeal.

While each state’s appeals process is unique, many states allow you to argue your case before a workers’ compensation board. This is where working with an experienced attorney can be helpful.

Our workers’ compensation lawyers understand what kind of evidence can bolster your appeal, and we have years of experience presenting appeal arguments to the court. The appeals process can be convoluted and frustrating. When you hire us, we’ll take the time to make sure you fully understand the steps you’ll need to take.

Can You Negotiate a Workers’ Comp Settlement?

The process of pursuing workers’ compensation benefits often involves negotiation. While you can negotiate with the insurance company yourself, you’re more likely to get favorable results when you have qualified legal representation.

The skilled team at Pond Lehocky Giordano understands which negotiation tactics tend to work with particular insurers. Insurance companies also have an incentive to settle with us. They know that if they don’t, we may file a lawsuit on your behalf.

If you’re having trouble working out a fair settlement, it may also be worth trying to work with your medical providers. If you explain your situation, some may allow you to pay your outstanding balance in installments.

When Should I Contact a Workers’ Comp Attorney?

If your workers’ comp claim has been denied and you believe it should be covered, contact our workers’ comp attorneys as soon as possible. During your free consultation, we can assess your situation and guide you through the next steps. If filing an appeal is your best option, we can represent you through the process.

You don’t have to wait for a claim denial to contact a lawyer. A workers’ compensation attorney can also help you put together and file your initial claim.

Let Pond Lehocky Giordano Assist You with Your Workers’ Comp Case

It’s easy to panic when you receive a workers’ compensation claim denial. However, when you have an experienced legal advocate by your side, you have a fair chance of filing a successful appeal. Pond Lehocky Giordano is invested in your success, and our commitment to our clients is reflected in our results.

You don’t have to face the uncertainty of a disputed claim alone. If your workers’ compensation claim has been denied, we may be able to set things straight. Contact us today to schedule your free consultation.