How Does Workers’ Compensation Handle Medical Bills?
Workers’ compensation generally covers all reasonable and necessary medical treatment related to a work injury, including doctor visits, diagnostic testing, physical therapy, medications, and surgery. In Pennsylvania, injured workers may be entitled to have 100% of their approved work-related medical expenses paid without deductibles or co-pays.
Does Workers’ Compensation Pay Medical Bills?
Yes. If you are injured at work, the Pennsylvania Workers’ Compensation Act generally requires your employer’s workers’ compensation insurance company to pay for reasonable and necessary medical treatment related to your work injury.
One of the biggest differences between workers’ compensation and private health insurance is that injured workers are generally not responsible for:
- Co-pays
- Deductibles
- Coinsurance
- Annual coverage limits for approved treatment
If the treatment is related to your work injury and considered medically necessary, the workers’ compensation insurance carrier may be responsible for paying the full cost.
What Medical Treatment Does Workers’ Compensation Cover?
Pennsylvania workers’ compensation may cover a wide range of medical treatment, including:
- Emergency room visits
- Primary care treatment
- Specialist appointments
- Orthopedic care
- Physical therapy
- Chiropractic treatment
- Diagnostic testing, including MRIs and EMGs
- Prescription medications
- Pain management treatment
- Injections
- Surgery
- Mental health treatment related to a work injury
Every case is different, but the focus is generally on whether the treatment is reasonable, necessary, and related to the work injury.
Can I Choose My Own Doctor After a Work Injury?
One of the most common misconceptions in Pennsylvania workers’ compensation is that injured workers must treat with a company doctor for a certain period of time. Many injured workers are told they must see the employer’s doctor for 90 days. In reality, the rules surrounding medical treatment can be more complicated, and injured workers often have more rights than they realize.
The most important consideration is receiving quality medical care from providers who are focused on your recovery and well-being.
If you have questions about your medical treatment rights after a work injury, it is often beneficial to speak with an experienced Pennsylvania workers’ compensation attorney.
Workers’ Compensation Can Cover Multiple Injuries
A workplace accident does not always affect just one body part.
For example:
- A fall may injure both your knee and lower back.
- A shoulder injury may lead to neck pain.
- An altered gait from a leg injury may cause additional back problems.
- A serious physical injury may contribute to depression, anxiety, or other psychological conditions.
Pennsylvania workers’ compensation may cover all accepted injuries and conditions that are related to the original workplace accident.
In some cases, additional injuries may need to be formally added to a workers’ compensation claim through the litigation process.
What If the Insurance Company Refuses to Pay for Treatment?
Insurance companies sometimes dispute whether treatment is:
- Related to the work injury
- Medically necessary
- Supported by medical evidence
When this happens, injured workers may have legal options available.
Depending on the circumstances, it may be necessary to file a petition with the Workers’ Compensation Court to establish the full extent of the injury and obtain an order requiring the insurance company to cover treatment.
Disputes over medical treatment are common in Pennsylvania workers’ compensation cases, particularly when significant injuries, surgery, or long-term treatment are involved.
What Is a Utilization Review in Pennsylvania Workers’ Compensation?
A Utilization Review (UR) is a process used to determine whether medical treatment is reasonable and necessary. The insurance company may request a Utilization Review if it believes certain treatment should no longer be covered.
A medical reviewer will evaluate the treatment records and issue a determination regarding whether the care meets Pennsylvania workers’ compensation standards. A Utilization Review does not necessarily mean treatment will stop, but it can affect whether the insurance company remains responsible for payment.
What Happens If My Workers’ Compensation Claim Is Denied?
Many injured workers assume they cannot receive treatment if their workers’ compensation claim has been denied.
That is not always the case.
Some healthcare providers who regularly treat injured workers may continue treatment while a workers’ compensation claim is being litigated. In certain situations, providers may agree to await the outcome of the case rather than requiring immediate payment.
If your claim has been denied, it is important to speak with an attorney as soon as possible to understand your options and ensure you continue receiving appropriate medical care.
Why Medical Treatment Is Important to Your Workers’ Compensation Case
Medical treatment serves two important purposes.
First, it helps you recover from your injury.
Second, it creates medical evidence that may be used to support your workers’ compensation claim.
Medical records often help establish:
- The nature of the injury
- The extent of disability
- The need for ongoing treatment
- Whether surgery is necessary
- Whether you can return to work
Consistent medical treatment can be one of the most important pieces of evidence in a workers’ compensation case.
Talk to a Pennsylvania Workers’ Compensation Lawyer
If you have questions about medical treatment after a work injury, Stern & Cohen can help.
Our Pennsylvania workers’ compensation attorneys help injured workers obtain medical care, challenge treatment denials, and fight for the benefits they deserve.
Contact Stern & Cohen today for a free consultation.
FAQs
Does workers' compensation pay all medical bills in Pennsylvania?
Workers’ compensation generally pays for reasonable and necessary medical treatment related to a work injury. Approved treatment is typically covered without co-pays or deductibles.
Do I have to pay a deductible for workers' compensation treatment?
No. Unlike most health insurance plans, Pennsylvania workers’ compensation benefits generally do not require injured workers to pay deductibles or co-pays for covered treatment.
Can workers' compensation cover mental health treatment?
Potentially. Psychological conditions such as depression, anxiety, or PTSD may be covered when they are related to a work injury or workplace accident.
Can I continue medical treatment if my workers' compensation claim is denied?
Possibly. Some healthcare providers may continue treatment while the claim is being litigated. An experienced workers’ compensation attorney can help explain your options and connect you with appropriate medical providers.