What Medical Expenses are Covered under Workers’ Compensation Benefits?

The workers’ compensation system requires employers in the United States to purchase insurance and provide benefits to their employees who experience work-related illnesses and injuries. If you get injured on the job or catch an illness, you can claim workers’ compensation benefits to pay for medical treatment. Some of the covered expenses include blood tests, imaging studies, hospital stays, doctors’ visits, emergency room care, and several others.

Each state has slightly different set of guidelines and regulations for the approval of medical care costs pertaining to workers’ compensation claim. In some cases, companies have contracts with doctors or hospitals that evaluate the condition of their employees and recommend medical treatment necessary for treating the work-related condition. The costs associated with the prescribed treatment are covered by the insurance carrier of workers’ compensation.

Medical Treatment Coverage under Workers’ Compensation Insurance

Generally, workers’ compensation covers any medical treatment that is recommended by your physician, and must be necessary for treating your illness or injury. Diagnostic tests such as ultrasounds, CT scans, x-ray, MRI’s, and other imaging studies are mostly covered if they are deemed essential for diagnosing and determining the extent of your condition.

The costs of the medical treatment your doctor recommends after the diagnosis are also covered, for which you need to file your claim. Workers’ compensation benefits cover medications, doctor’s visits, hospitalizations, and surgeries. In some situations, your travel expenses to the medical facility for doctors’ appointments and tests are reimbursed. If you need an adaptive device, e.g. a wheelchair, it will be covered as well.

Workers’ Compensation Benefits for Alternative Treatments

Western medicine and some alternative treatments are covered under the workers’ compensation insurance. However, naturopathic, biofeedback, acupuncture, and some other treatments may not be included. Similarly, expenses incurred for treatment modalities and experimental drugs will most probably be denied.

If you think any alternative treatments that are not included in workers’ compensation insurance will be beneficial for your condition, you can opt for them. There is no restriction on getting uncovered treatments if you are able to pay for them yourself. You may also try to convince your insurance carrier to cover them, but the chances of its approval are quite slim.

Vocational and Physical Rehabilitation

If your condition requires you to get physical rehab for completely recovering from your illness or injury, its expenses will most likely be covered. Rehab includes massage therapy, chiropractic, care, physical therapy, and occupational therapy. However, you need to keep in mind that while they are covered under workers’ compensation system in most states, there are usually limits on how many times you can avail a particular treatment.

The Payment of Medical Bills

Once you file for a workers’ compensation claim, the insurance carrier company will pay your medical expenses immediately after it is approved. If you are receiving a continuing treatment, the bills will be paid as you incur the expenses till your claim remains open. While the insurance company usually requires the employee to get a pre-approval, this is something your physician can take care of as well.

Workers’ compensation insurance is a right of every employee working under a U.S. employer. If your employer is denying your claim, you need to fight back to get your rightful benefits. Contact Fisk & Monteleone Ltd. today at 815-209-9030 to schedule a free case consultation with one of our experienced workers’ compensation attorneys.