Once a workers’ compensation claim has been submitted and approved, the injured employee may not be sure what to do next. Medical expenses are standard claims made under these policies, but what do those claims include? If an ambulance was required when the accident or injury occurred, is that cost allowable in a workers’ compensation claim?
We have asked attorney Alaina Sullivan about what you should do. Here is what she had to say:
What Is Covered under Workers’ Compensation?
Workers’ compensation is a form of insurance that gives employees wage replacement and medical benefits in the event of an injury during the normal course of employment. Employees who choose to use workers’ compensation benefits voluntarily waive their right to then sue the employer for negligence in a personal injury.
The expenses normally covered in a workers’ compensation policy include medical care resulting from the injury or illness, replacement income, costs for retraining that may be needed as a result of the injury, compensation for permanent injuries, and benefits to survivors of the deceased worker if the injury resulted in a serious injury. However, what is not covered are pain and suffering among a handful of other costs.
What Costs Are Included in Medical Expenses
The workers’ compensation policy will cover any medical expenses that result from the work-related accident or injury. These expenses cover trips to the emergency room, x-rays, doctor’s visits, and other medical bills. Expenses for an ambulance ride can be covered, as well, especially if the ambulance was needed to get the employee from the place of employment or where the injury occurred to the hospital to receive the necessary treatment. Even if it is not 100 percent clear whether the ambulance was absolutely necessary, it is likely that the expenses will still be covered.
Submitting the Expenses for Reimbursement
The employee’s medical provider may not have the required workers’ compensation insurance information at the time of service. Odds are if the expenses come from day of the injury or close to it, the workers’ compensation claim information may not even be available. For this reason, the injured employee will likely receive the bills upfront. The employee should give the medical provider the insurance adjuster’s contact information, including name, phone number and the claim number. This information should also be provided to the ambulance company.
Once this information has been given to the medical provider, in many states, the medical providers is legally barred from continuing to contact the injured party. If a medical provider continues to contact the injured employee despite the fact that the claim information has been given, he or she should contact the insurance provider directly. If that route is ineffective, the employee is encouraged to contact a workers’ compensation attorney who can take care of this harassment on behalf of the employee and ensure that all claims are properly submitted and paid.
Workers' compensation laws vary wildly depending on where you live. To learn more about workers' compensation in your home state, read our pages on state-specific workers' compensation laws.
Panel Providers Versus Emergency Care
When a medical claim is submitted under a workers’ compensation policy, normally the employee is required to utilize the services of a medical provider under the official “panel” of providers from the insurance agency. This requirement can cause conflict later on down the road if the doctor provides a diagnosis that the patient does not necessarily believes is accurate, and it can force the employee to use the services of medical providers that he or she would not normally use in most circumstances. However, when an ambulance is called, this call is normally made in an emergency situation.
There is not enough time to review where the ambulance will take the employee and who the ambulance provider is, and even though the workers’ compensation insurance provider may attempt to dispute the claim, if it is deemed to be medically necessary, the ambulance ride may still be covered even if the provider is not included in the insurance company’s official “panel” of providers. A workers’ compensation attorney can assist in ensuring that this claim is paid in the event a dispute occurs.
Contact an Attorney Today
If you have been involved in an accident on the job and have questions about what types of expenses are allowable under your workers’ compensation claim, it is highly recommended that you contact an attorney to answer your questions. A licensed attorney trained in workers’ compensation law will be able to review your case and determine your best course of action. To receive the compensation you deserve, contact an attorney in your area today.
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