How Does Workers’ Compensation Handle Medical Bills?

February 14, 2022
Stern & Cohen
medical billing statement on clip board

When you suffer an unfortunate injury at work, the Pennsylvania Workers’ Compensation Act requires the employer/insurance company to pay for medical treatment related to your work injury.  Unlike many private health insurance policies, if you suffer a work injury, 100 percent of your medical bills must be paid.  There are no co-pays nor deductibles.  There are no caps on the amount of treatment that you may receive.

What Medical Treatment is Covered?

Reasonable, necessary and related medical treatment for your work injury must be paid by the employer/insurance company.  There are many myths out there about whom an injured worker is permitted to treat with.  Let me set the record straight:  if you are injured at work, you are permitted to see any health care provider that you choose.  You are not “obligated” to see the company doctor for 90 days, or any period of time for that matter.  This is a myth that seems to have gotten a lot of traction in Pennsylvania amongst employers and insurance companies.  They then coerce an injured worker into thinking this is some type of rule.  I have spoken to so many injured workers who have told me that the employer or the insurance company (or both) have convinced them that they must see a certain doctor or facility for some period of time.  I have even had doctors ask me about this because they are convinced that is some type of law here.  It is not.  Choose a doctor that will have your health and your body’s best interests at heart.  Do not go see a doctor that is motivated by getting more referrals from the employer/insurance company.  That is a terrible conflict of interest and often results in undesired outcomes for injured workers.  There are many doctors in the Commonwealth that will evaluate and treat injured workers and do so with the goal of helping you get better and recuperating on your terms.  I cannot even count how many times an injured worker has come to me and said, “my doctor told me that he had to release me to work because he was getting pressure from the insurance company.”  Huh?  Since when does an insurance company have the right to dictate the terms of an injured person’s care.  This is unacceptable and I tell my clients this.  Find a new doctor.

The scope of your treatment should be based on what you need.  If you need diagnostic studies – MRIs, EMGs, etc. – that will be paid.  If you need traditional physical therapy or chiropractic treatment, this is also covered under the law.  If you require medication or injections, the employer/insurance company must pay for this.  Finally, if surgery is recommended, that will be reimbursed in full.  Furthermore, injuries at work may involve one body part or multiple areas of your body.  Whatever is injured, the employer/insurance company must cover.  If you fall and hurt your knee and lower back, both must be addressed.  If you fall and hurt your knee and limp around for weeks and later develop lower back pain as a result, again, both areas of the body must be covered.  If you severely injure your neck and after a good deal of pain, treatment and being out of work and not having your normal way of life, you start to develop depression and anxiety – mental health treatment should be covered.  There are no boundaries here.  Whatever you require from a medical standpoint to rehabilitate your work injury should be paid.

Obviously, there can be pushback from the insurance company about what treatment they pay for.  However, that is why the law gives us a wonderful right called “due process.”  We can file Petitions in Court to prove the full extent of your injuries and convince a Judge to order any treatment to be paid.  This is your right.  You should never be deterred by what injuries the employer/insurance company formally “accepted.”  This can be changed and quality legal counsel can guide you here.  If the treatment is deemed related, they must pay 100 percent of the bills.  The employer/insurance company always has the right to “review” your care and that is fair.  But, we always tell our clients that their focus should be on doing treatment that helps them get better.  Let us take care of the rest.  The “utilization review” process is better explained here.

What If My Claim Is Not Accepted?

Call us!  There are many reputable doctors that are willing to see injured workers, despite a claim being denied.  They will not bill you.  They will not ask you for a co-pay.  They will keep track of their bill and await the successful resolution of your case.  If, for whatever reason, the case does not go your way, the doctor will write off their bill.  This is the cost of doing business and the health care providers that are passionate about helping injured workers are more than happy to take this risk on your behalf.  Do not let the employer/insurance company bully you by denying your claim in the hopes that you will not seek treatment for your injury.  There are systems in place that can enable you to still get what you need, even in the face of unreasonable behavior by the employer/insurance company.  You will certainly need experienced counsel to guide you through this and help you find the right care if your claim is denied.

Seek Help From a PA Workers’ Compensation Attorney

If you have any questions about obtaining medical treatment for your work injury, call us.  The consultation is always FREE.