How is my medical care covered under work comp insurance? – II

Aug 09 2016

In a previous post, we started discussing how authorized medical providers treating injured workers should seek reimbursement for all reasonable and necessary medical expenses from an employer’s workers’ compensation insurance carrier once the Admission of Liability has been filed.

We also discussed how employers are free to create a list of designated physicians from whom injured workers must seek care and what happens if the employer fails to take this step.

We’ll continue this discussion about workers’ compensation and medical benefits in today’s post.

What expenses will an injured worker be responsible for covering?  

As we mentioned above, all reasonable and necessary medical expenses provided by a designated physician(s) or authorized provider are covered by workers’ compensation insurance. This means you, the injured worker, should never receive a bill for their medical services, or the difference between the amount charged and the amount covered by the insurer.

What exactly do reasonable and necessary medical expenses include?

In addition to the care provided by the designated physician, if he or she refers you to another physician for treatment related to your work injury, this should be covered as a reasonable and necessary medical expense.

In addition, reasonable and necessary medical expenses such as prescriptions and supplies should be covered, in addition to the mileage to and from your various appointments with providers.

What happens if a medical provider sends me a bill for a reasonable and necessary medical expense?  

While all bills for medical expenses related to the work injury should be remitted to the insurance carrier, there’s always a chance that bills can be sent to you. If this happens, the Colorado Division of Workers’ Compensation advises forwarding it to the insurer for payment.

Once this is done, the insurer has 30 days to make the necessary payment or provide you with a reason for nonpayment. If the latter occurs, you may contact the insurer to see if additional information is required.

If the insurer still refuses to make payment, legal action may prove necessary.

We’ll continue discussing this topic in future posts.

Consider speaking with a skilled professional as soon as possible to learn about your rights if an insurer is refusing to cover your medical expenses.