Section 30, Chapter 152: Medical and Hospital Services; Physicians Other Than Insurer’s; Artificial Eyes or Limbs or Appliances
When you are injured on the job in the Boston area a significant portion of your benefits will involve payment of medical expenses. Pursuant to Chapter 152, Section 30 of the Massachusetts General Laws (MGL), this can include payment for various types of medical treatment, hospital services, physician services, and other durable medical devices.
While it may seem redundant to list medical services, hospital services, and physician services separately, this is the nature of how our healthcare system works in the United States. Injured workers are often billed for every portion separately. For example, if you are injured at your Boston workplace, and that injury is very serious in nature, you will likely be taken to the hospital via an ambulance. When you get to the hospital, you will be treated by the emergency room staff and then possibly taken to a surgical suite. Following surgery, you will be in the recovery room and then will likely be transferred to a rehabilitation center. You may also have physical or occupational therapists and possibly home nursing caretakers come to you once you have been released from the rehab facility.
As our Boston workers’ compensation attorneys can explain, all services will be billed separately. This means you will be billed separately for each service rendered. For example, the company that provided the ambulance ride will mail you a bill. The greater Boston area has ambulance rates that often exceed many other major cities. An ambulance ride of less than a mile can sometimes cost more than $1,000. In addition to the ambulance bill, you will also get a bill for hospital services and equipment used during your treatment. You may also get a bill for the physicians’ and the surgeon’s services. You will get a bill for the anesthesiologist, the equipment used during surgery, the rehabilitation facility, and home health care workers involved in your care. The sheer amount of paperwork you receive from medical facilities and billing collection companies and be overwhelming, never mind the costs of all these services.
Insurer Shall Pay for Reasonable Health Care Services
Section 30 of Massachusetts General Laws Chapter 152 requires the workers’ compensation insurance company to pay for reasonable health care expenses for the injured worker. The question that arises is what are “reasonable” health care expenses. As one might expect, the patient’s and doctor’s view of reasonableness might differ from greatly those of the insurer. For well over a decade, these insurance companies have made a living off of turning large portions of their revenue into profits. They do so by collecting as much in premiums as they can while denying as many claims as possible. When it is not feasible to simply deny a claim (such as when the injury is clearly incapacitating), the company may to try to pay as little as possible, and they can do this by denying medical treatment.
Another way the insurance company saves money is by pushing patients to see doctors in their network of health care providers. Any doctor you treat with that is within the network will have an agreement with the insurance company. The doctor agrees to accept injured workers in exchange for a negotiated rate of payments. This allows the insurance company to exert leverage over the health care providers. Doctors will still exercise their independent professional judgment, but they also will be aware of who is helping maintain their revenue stream.
Section 30 allows for the insurance company to require the injured employee to undergo a physical exam one time per year while the employee is hospitalized. In addition, the employee has the right to change his or her doctor one time in order to obtain a second opinion if they do not like that provider, or are not comfortable with that health care provider. This is also true when the worker is referred to a specialist for some other type of medical procedure. One second opinion from another specialist in the field is permitted and the insurance company is required to pay for it.
Other Provisions of Chapter 30
Section 30 of Chapter 152 also addresses the issue of what happens when an injured employee needs an artificial eye, limb or another type of mechanical appliance. The statute says that the company shall be required to pay for the artificial eye, limb, or mechanical appliance when the use of such medical device will promote restoration and rehabilitation of the injured worker and will increase the chances that he or she can go back to work.
The statute also discusses medical benefits in the context of a collective bargaining agreement. A collective bargaining agreement is an agreement entered into between an employer, and typically the employees through a union. While an individual employee may not have a lot of power in terms of making demands about what type of health care options or other benefits should be available to injured workers, through union representation, workers can increase their leverage through their sheer strength in numbers. Even if there are not that many workers at an individual workplace, many unions have much larger chapters all over the country or even the world, and these numbers can be leveraged to assist a small chapter of a local union.
All of this can be rather confusing to the average worker who was injured on the job in Boston and is just trying to get his or her bills paid and get workers’ compensation benefits for lost wages. For this reason, the best thing you can do is to speak with an experienced legal team about the facts or your individual case. You need someone who will put your interests first, treat you with respect, and fight for your right to a full and appropriate workers’ compensation benefits award. It is also important to know that there is no fee to you unless we are successful in obtaining your workers’ compensation benefits.
Contact the Law Offices of Jeffrey S. Glassman today for a free and confidential consultation.