You could be liable for the medical bills if workers’ comp denies your claim. Depending on your state, you may challenge the decision through a secondary medical evaluation and appeal. A workers’ compensation attorney can be a critical ally in the fight for benefits after your work injury. The simple answer to what happens to your medical bills after workers’ comp is denied, is that they become your responsibility. However, there are several things you can do to help mitigate those costs.
Challenge The Workers’ Compensation Denial
Workers’ compensation insurance carriers are not motivated to pay out claims. Some carriers may deny your claim, hoping that you won’t fight it. Fortunately, every state has the option to contest a workers’ compensation denial. Depending on your state’s workers’ comp laws and procedures, you could:
- Request an independent medical evaluation
- Request a hearing with an arbitrator
- File a petition contesting the decision
- File a formal appeal
- Request a claim adjustment
The appeal process often includes a formal hearing with an arbitrator, judge, or board. When you challenge a workers’ comp denial, you must gather evidence to prove your claim and refute their explanation for the denial.
Reasons Workers’ Comp Might Deny Your Claim
Workers’ compensation carriers give many reasons for claim denials. Understanding the denial reason can guide you to the evidence you need to issue a challenge. Common reasons for workers’ comp denials include:
- You or your employer missed workers’ comp deadlines.
- You did not seek medical treatment.
- The injury or illness was not work-related.
- The injury or illness did not occur while performing work activities.
- The injury or illness was a preexisting condition.
- The injury or illness was not severe enough to file a claim.
- The injury or illness was not covered by workers’ compensation.
- You were not a direct employee.
- You were an employee excluded from workers’ comp coverage.
- The injury or illness was due to negligence.
When establishing a solid defense against a workers’ compensation denial, an attorney who handles workers’ comp claims can help. They can attend hearings, arbitration, and trial proceedings to defend you against the workers’ comp administrator’s claims. While no outcome is guaranteed, your attorney can aggressively advocate for the workers’ compensation benefits you deserve.
File a Claim Through Your Health Insurance Coverage
Sometimes an appeal isn’t successful, and you must handle medical bills on your own. One option is to file a claim through your group or personal health insurance or that of your spouse. While health insurance typically declines claims for work-related injuries, they must cover your medical bills if workers’ compensation denies your claim.Your insurance company may ask you to sign a form indicating that your workers’ comp claim is in dispute. If your workers’ comp appeal is successful, your health insurance will expect you to pay them back out of your workers’ comp settlement. If you have trouble receiving assistance from your health insurance after a workers’ comp denial, an attorney can help you negotiate with both the workers’ compensation insurance and your medical insurance provider.
Check Your Eligibility for Medicare or Medicaid
If you or your spouse do not have health insurance, you may meet the eligibility requirements for Medicare or Medicaid coverage.
Medicare Coverage Requirements
Medicare is a federal health insurance program administered by the Social Security Administration (SSA), available for individuals over the age of 65 and people who have qualifying disabilities or conditions. If you qualify for Medicare coverage, you could file a claim to have your medical costs covered after a workers’ comp denial.
Medicaid Coverage Requirements
Medicaid is a health insurance program governed on a federal level and administered on a state level. The federal government mandates Medicaid coverage for certain low-income groups and other qualified individuals, and some states expand their requirements to include others. The Affordable Care Act of 2010 outlines Medicaid eligibility calculations and requirements. If you qualify for your state’s Medicaid program, you could seek to have your medical bills paid by Medicaid.
Ask the Medical Care Provider for Assistance
If your appeal for workers’ compensation fails, and you don’t have sufficient health insurance coverage to pay medical bills, you could request assistance from the medical care provider. Many hospitals and other care providers offer discounts for uninsured individuals. Your medical provider may also agree to a payment plan.Workers’ compensation attorneys often deal with health care providers and workers’ compensation carriers. They can help you negotiate lower medical bills and establish a payment plan that works for you.
Hire a Workers’ Compensation Attorney to Defend Your Rights
Workers’ compensation laws exist to protect workers like you from paying for injuries you sustain on the job. A workers’ compensation lawyer can help you defend your legal right to fair compensation after a workplace injury or illness. An attorney can aggressively pursue workers’ compensation benefits on your behalf. There are many advantages of having a lawyer on your side throughout the workers’ comp claim and appeal process. They can:
- Gather the necessary evidence to prove your claim
- Recognize and counter violations of your legal rights
- Defend you against unfounded, unfair, and false accusations
- Negotiate with your employer, workers’ comp, health insurance, and medical providers
- Handle correspondence, phone calls, and legal filings
If your workers’ compensation claim was illegally denied or your injury was due to someone else’s negligence, your lawyer can also consider filing a lawsuit against the responsible party.
Consult a Dedicated Workers’ Compensation Lawyer at KJT Law Group
Now that you understand what happens to medical bills if workers’ comp is denied, you can move forward with an appeal, insurance claim, or legal action. The workers’ comp attorneys at KJT Law Group understand the stress you face after a claim denial. Contact our workers’ comp lawyers online or call (818) 507-8525 today to discuss how we can help with your workplace injury claim and related medical bills.