Our clients are often faced with a huge obstacle to getting the medical care they need for a work injury: their workers’ compensation case is denied. This can result in an inability to get needed treatment. Most doctors insist on getting paid for their services. It’s not uncommon for doctors – particularly specialists – to refuse to treat an injured worker if his case has been denied. This can delay recovery or even leave the injured worker entirely untreated.
Here are the steps to getting the medical care you need if your insurer refuses to pay. Obviously, we work from the presumption that your attorney has filed a Claim Petition to get your injury acknowledged as work-related. These alternatives
1) Health insurance
Your first option is to use your personal health insurance, which is usually provided by your employer. Your private health insurer must cover your work-related medical charges IF your workers’ compensation claim has been denied. You should provide the insurer with a copy of the Denial issued by the insurer. If and when you are successful in your workers’ compensation case, the health insurer should be reimbursed by the workers’ compensation carrier.
If your employer has terminated your medical coverage, you may qualify for COBRA continuation benefits. Needing medical care is a strong incentive to maintain COBRA continuation coverage. Unfortunately, you have to pay the monthly premiums for your policy. The good news is that you can get up to a 60% discount off these COBRA premiums, thanks to the Obama administration.
2) Public Assistance
Your next option is to apply for medical insurance through public assistance. While there are strict guidelines for qualifying, this insurance will at least get you in to see a doctor.
3) Family doctor
Your family practitioner remains a valuable asset in your fight to be treated. She may agree to treat you while your case is being litigated, with the promise of payment if and when you are successful. This is a strong incentive to see your family doctor regularly before problems arise.
If none of these alternatives gets you the treatment you need, talk to your lawyer and ask what other alternatives there are.