How is my medical care covered under work comp insurance?

Jul 29 2016

As we discussed in a previous post, once an employer’s insurance carrier determines that an injured worker is entitled to workers’ compensation benefits, it will issue what is known as an Admission of Liability.

While this might seem like not much more than a just another step in a seemingly arcane process, it’s actually very significant from the standpoint of medical benefits. That’s because once the Admission of Liability is filed, it means all authorized medical providers will seek reimbursement directly from the insurance company going forward.

What exactly does workers’ compensation insurance cover in terms of medical expenses?

So long as you receive medical care from a designated physician or authorized provider, workers’ compensation insurance should cover all reasonable and necessary medical expenses.

What does it mean to see a designated physician?

It’s important to understand that an employer is given the right under state law to designate the medical providers that injured employees must use.

State law also dictates, however, that most employers must provide injured workers with a choice as to medical provider. Typically, these choices are laid out via designated provider lists outlining all physicians from whom the injured worker could potentially seek treatment.

What if an employer has not properly designated any physicians?

If an employer has not properly designated any physicians, an injured worker is free to select his or her own provider. However, it’s possible that once a claim is filed, the insurance company will request that the injured worker undergo an examination by a physician of its choosing.

Failure to attend this examination could result in the insurance company requesting permission from the Colorado Division of Workers’ Compensation to discontinue work comp benefits.

We will continue this discussion about workers’ compensation and medical benefits in our next post.

If you have been injured in a workplace accident or suffered a work-related injury, and an insurer is refusing to cover your medical expenses, consider speaking with an experienced legal professional to learn about your rights and your options.