Medical Expenses for Workers’ Compensation in Massachusetts

In addition to lost wages , workers’ compensation in Massachusetts is designed to compensate employees who are injured at work for medical expenses related to the injury or work - related illness .

Who Qualifies for Medical Benefits in a Massachusetts Workers’ Compensation Claim?

Pursuant to the Executive Office for Labor and Workforce Development (EOLWD), workers’ compensation medical benefits are available to anyone who’s injured on the job or suffers from a work-related illness that requires medical attention. The Massachusetts workers’ compensation system is a no-fault system. An injured worker is entitled to medical benefits and other compensation regardless of whether they were at fault for the accident or someone else is to blame for the work injury.

A work related-illness can come in many forms and may result from occupational exposure to hazardous chemicals or other toxins, as well as viruses and bacteria in certain situations. At Jeffrey Glassman Injury Lawyers one of the typical workplace illnesses we deal with is mesothelioma. In almost all cases, mesothelioma is related to asbestos exposure.

When someone breathes in asbestos dust, fibers can become lodged in a layer of tissue known as the mesothelium, which lines the thoracic cavity, abdominal cavity, and heart sac. In time, those fibers can metastasize into a deadly form of cancer known as mesothelioma , lung cancer, or other respiratory illness.

Symptoms of mesothelioma include cough, chest pain, and shortness of breath. Mesothelioma can be treated with surgery, radiation, and chemotherapy, but there is no cure. There are less than 20,000 cases of mesothelioma per year in the United States, according to data from the Mayo Clinic.

Occupational exposure to asbestos is the top cause of mesothelioma. Workers at high risk include construction workers, firefighters, industrial workers, power plant workers, and shipyard workers. Anyone working with or even near asbestos should wear personal protective equipment, including respirators.

For other occupational illnesses, coverage will depend on whether the employee is regularly expected to come into contact with a particular virus or bacteria and what steps the employer has taken to protect a worker. A recent example of this is tuberculosis, which is becoming more prevalent in urban areas throughout the country, as well as the novel coronavirus, also known as COVID-19, which has killed thousands of Massachusetts residents.

Workers at high risk of contracting COVID-19 are first responders, such as police officers and firefighters, and essential workers, including healthcare workers, nursing home workers, and grocery store workers.

What are Medical Benefits?

Employees who are injured or become ill due to their work are entitled to compensation for adequate and reasonable medical care, cost of prescriptions, and mileage reimbursement for traveling to and from a healthcare provider.

M.G.L. c.152, § 13, which pertains to the payment of workers’ compensation medical benefits, states: “The insurer shall furnish to an injured employee adequate and reasonable health care services, and medicines if needed, together with the expenses necessarily incidental to such services.”

What qualifies as “adequate and reasonable” medical care? Generally, emergency room visits, hospital stays, diagnostic tests such as X-rays and some physical therapy are considered adequate and reasonable and can be covered under your workers’ compensation benefits.

However, other types of medical care could be questioned and compensation for these expenses denied. Some examples include:

  • Specialized medical equipment
  • Alternative treatments such as acupuncture, chiropractic treatments and massage therapy
  • Psychiatric care
  • Experimental treatments

Your workers’ compensation attorney can advise on the types of medical treatments that are likely to be covered and can assist if medical benefits are improperly denied.

Medical benefits claims can be denied for a variety of reasons. Your employer’s workers’ compensation insurance carrier might argue that you didn’t hurt yourself at work, you had a preexisting condition, or your injury isn’t as serious as you say it is.

It’s important that you report your work injury to your employer as soon as it happens. They may try to tell you not to seek treatment, or if you do, to tell the doctors you got injured at some place other than work. It is important that you are honest with the doctors, and tell them if your injuries came from a work accident. Lying can significantly hurt your chances of obtaining workers’ compensation benefits later.

Another thing you can do to maximize your chances of obtaining compensation for all your medical expenses is to see a physician as soon as possible after your injury—even if your injuries seem minor. If you wait too long, skip a visit to the doctor, or try to work through your injuries, you may make your injury worse. This will also make it more difficult to prove that you injured yourself at work.

Can Employees Receiving Medical Benefits Choose Their Own Doctor?

Under EOLWD regulations and Massachusetts law, your employer has a right to designate where their employees first receive medical treatment after a work accident. Once initial treatment is complete, however, the injured worker may be seen at any healthcare provider that accepts workers’ compensation payments.

Under M.G.L. c.152, § 13, an injured worker has the right to select his or her own doctors and other health care providers and control his or her medical treatment. The insurance company can occasionally require an injured worker to be evaluated by a doctor of the insurer’s choosing from time to time.

One of the questions our workers’ compensation attorneys are often asked is if injured workers are required to pay out-of-pocket for medical bills. Some injured workers pay themselves with the expectation that they later can get reimbursed from a medical benefits award. If you are receiving bills in the mail, the medical facility is probably billing the wrong insurance company. All medical treatment should be paid by the workers’ compensation insurance company and you should not have any out of pocket expenses.

Under Massachusetts workers’ compensation law, the employer’s insurance company is required to give injured workers an insurance card with a claim number and contact information. The injured worker can then present this medical benefits card to the healthcare provider they are seeing, and that provider can directly bill the workers’ compensation insurance carrier. The workers’ compensation insurance company should also cover any prescriptions associated with your care.

Many injured workers ask about how long they can expect to receive workers’ compensation medical benefits . Under Massachusetts law, injured workers are entitled to receive medical benefits for as long as they need medical care and treatment. In certain cases, workers are entitled to medical benefits for the rest of their lives.

If your employer asks you to use your own health insurance for a work injury, you should speak to a workers’ compensation attorney as soon as possible.

To learn more about how our work accident attorneys can help you with your workers’ compensation claim, contact Jeffrey Glassman Injury Lawyers today at (617) 777-7777 or using our online form.

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