Workers’ comp is not a perfect system, and sometimes things can wrong or fall through the cracks. If an employee filed a valid claim, workers’ comp should cover all their medical expenses resulting from the work-related injury. If anything goes wrong with this process, it is important to find out what went wrong with the claim and get it corrected.
An employee should file a workers’ compensation claim as soon as possible after a workplace injury or illness occurs. The process involves the following steps:
When workers’ compensation insurance refuses or discontinues medical treatment, it is often for one or more of the following reasons:
If your employee is unsure of why their medical treatment has been discontinued or refused or why their medical bills are not being paid, they may request an explanation in writing from the insurance company. Problems often arise because of miscommunication, incorrect or incomplete information, or delays in receiving information. Many problems can be resolved by you and the employee communicating with the insurance company. If not, their next step is to request a conference with an administrative law judge to discuss the concerns.
If an employee has filed a claim for compensation, they may request an evidentiary hearing in which a judge will decide if you are required to cover their medical treatment. They will have the burden of proof and will need to provide medical evidence. In the meantime, they are protected against collection efforts by medical providers if they notify the provider in writing by certified mail that the healthcare services provided involve a workers’ compensation claim.
Workers’ compensation claims can be complicated, so if you are a business owner, it’s important to have the proper workers’ comp insurance in order to protect your company. Contact your local agent today for more information.