Types of Medical Care That May be Covered by Workers’ Compensation

asian-woman-neck-braceGeorgia’s workers’ compensation system covers reasonable and necessary medical bills for as long as treatment is authorized. However, what does reasonable and necessary mean?

Roden Law’s Albany workers’ compensation attorneys explain how medical benefits are covered under a workers’ compensation claim. If you were injured at work or are suffering from an employment-related illness, you may be eligible for compensation – contact us today for a free, no obligation consultation.

What is Generally Covered?

Workers’ compensation typically approves some basic medical expenses without question, such as:

  • Basic diagnostic tests
  • Painkillers prescribed immediately after the injury occurs
  • Limited physical therapy for your recovery

Typically, emergency room care immediately following an accident is covered by the workers’ compensation system, this may even include surgery.

It may be possible to have additional medical care approved if it is necessary for your treatment, though there may be some pushback from your employer or its workers’ compensation insurer.

For your treatment to be covered by workers’ compensation, it must be:

  • Provided by a doctor who is authorized by the employer’s insurance company
  • Reasonably necessary to relieve your pain, improve or cure your medical problem or allow you to return to work
  • Billed corresponding to the worker’s compensation fee schedule

When Might Coverage be Denied?

There are various types of medical care the workers’ compensation system might not cover, or the insurer may take time to consider whether the treatment you are seeking will be covered:

  • Surgery
  • New and/or experimental treatments unsupported by significant research
  • Specialized treatment ordered by a non-specialist medical provider
  • Extensive diagnostics
  • Duplicate treatments ordered by more than one doctor
  • Pain management
  • Psychiatric treatment
  • Alternative treatments
  • Care from attendants with little to no medical experience or training
  • Home modifications after a disabling injury
  • Specialized medical equipment beyond basic models

Even though the recommended treatment may be medically necessary to improve or cure your condition, the workers’ compensation insurance company may deny coverage. This is where hiring an experienced workers’ compensation attorney can be helpful.

Your attorney can advocate for you with the workers’ compensation insurance company about covered treatment.

How are Bills Generally Paid?

Generally, your employer or it’s workers’ compensation insurer directly pays approved medical expenses. Usually, you do not have to personally pay for your medical care, unless it is not covered by the workers’ compensation system.

When you receive medical care for a work-related injury, inform the health care provider that your injury happened at work. Give your health care provider the name and address of your workers’ compensation insurance adjuster, as well as your workers’ compensation claim number to reference when bills for your treatment are submitted.

If you receive a medical bill related to your workers’ compensation injury, contact the health care provider and give them the contact information for your adjuster as well as your workers’ compensation claim number. If you continue to receive bills for related care, forward them to your workers’ compensation attorney.

If you do pay for a covered treatment or service out of your own pocket, you are entitled to receive reimbursement. This may include your travel expenses to authorized medical appointments, such as mileage and parking fees.

Get Help from Our Attorneys

Reasonable and necessary medical treatment and a portion of lost wages may be covered after a workplace injury.

Request a free, no-obligation consultation with Roden Law’s experienced attorneys to find out if you may qualify for workers’ compensation benefits. We charge no upfront fees and you only pay us if we recover compensation for you.