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Workers' Comp Medical Benefits FAQs

Who will pay my medical bills for a work-related injury?

When you suffer a work-related injury, you must file notice of the injury to your employer. Your employer must then submit a claim to the workers’ compensation insurer that covers you. The workers’ compensation insurer has to pay medical bills and medical costs. The insurer has 14 days from receiving notification from your employer to either approve the claim and start paying bills or to deny the claim and provide information on the reason for the denial.

Can my employer choose my doctor when workers’ compensation is paying my medical costs?

Your employer generally cannot choose your doctor even when workers’ compensation is paying. Under certain circumstances, however, a different rule may apply. For instance, if your employment contract gives your employer the right to provide a list of doctors or if your collective bargaining agreement establishes limits on your right to choose your doctor, then you may be required to go to a doctor of your employer’s choosing.

What types of medical bills does workers’ compensation cover?

Workers’ compensation should extend to cover all medical bills arising as a result of your work injury. This can include doctors visits, hospital visits, emergency care, lifesaving medical care, surgery, pain medications or anything else required or recommended by a licensed physician in treating your case.

Does workers’ compensation cover hospitalization or surgery?

If hospitalization and/or surgery is necessary as a result of a work injury you suffered, then workers’ compensation will pay for the costs. The treatment must be reasonable and customary for your condition. If there is a dispute over whether a given type of treatment is reasonable or medically necessary, then it becomes very important to contact a Massachusetts’ workers’ compensation lawyer for assistance.

Does workers’ compensation cover medical testing?

Medical testing is a type of medical treatment and care that should be covered under workers’ compensation as long as the testing is necessary as a result of a work-related injury or accident.

How long will my medical benefits through workers’ compensation last?

Your employer must continue to pay medical costs and medical bills that you need as a result of your work injury. Your employer has to pay these bills for as long as it takes for you to recover from your injury. In some cases, your employer may have to pay for medical care for the rest of your life if your work-related injury or illness is an ongoing condition.

Can my employer require that I use my own health insurance?

Your employer can neither require or suggest that you use your own health insurance to pay for medical care that you need as a result of a work injury. If your employer does try to push you into using your own health insurance, you should speak with a lawyer.

When you use your own health insurance, you may have co-pays that you are responsible for and that would be covered by workers’ compensation. In this and in important other ways, your health insurance policy will not provide you the same type of comprehensive full coverage that workers’ compensation should provide.

Why is it important to get medical treatment immediately?

Whenever you suffer a work-related injury, you need to get treatment right away. This is true for many reasons, including the most obvious one- you need to preserve your health. What may appear to be a minor injury or medical condition could actually turn out to be a major one if the injury doesn’t heal right or if it doesn’t have immediate and obvious symptoms. If you have not gone to a doctor to get medical treatment and it later turns out your injury is very serious, then it may be harder for you to make a claim under workers’ comp and to prove your injury arose because of work.

What if I want to switch doctors?

If your medical bills are covered by workers’ compensation and you wish to switch doctors, you may do this. However, you can typically only switch once within each specialty.

Will I be responsible for paying a co-pay?

You should not be responsible for paying any type of co-pay when you receive medical treatment arising from a work injury covered by workers’ compensation.

How will my medical bills be paid?

The doctor or healthcare provider treating your work injuries will generally send bills directly to the workers’ compensation insurer. You will not have to pay the bills or wait to be reimbursed.

What if I need transportation to my medical appointments?

Under Massachusetts law, the workers’ compensation insurance company should pay the costs of providing travel to medical appoints.

Am I required to submit to a medical exam requested by my employer’s workers’ comp insurer?

If your employer’s insurer requests that you undergo a medical exam, you will need to go. If you fail to go to required medical examinations, your benefits can be stopped or it may take longer to receive your benefits since your refusal can be seen as interfering with an investigation into your workers’ comp claim.

Are doctors required to accept workers’ compensation cases?

There is no requirement that doctors agree to treat patients who have suffered a work injury and who are seeking treatment that will be paid for by workers’ compensation.

Can doctors refuse to continue treatment if an injury is a work injury?

If your doctor determines that an injury or illness you were seeing him for is a work injury, your doctor is not legally obligated to continue providing you with treatment. If your doctor does not handle workers’ compensation claims and/or doesn’t want to wait for payment from the workers’ compensation insurer, the doctor can decline to continue to provide you with treatment. Some doctors will decline to continue treating since they are required to accept rates set by the state and/or by the workers’ comp insurer when workers’ comp is paying the bills.

Can my employer stop paying my health insurance costs when I am out of work as a result of a work accident?

While injured workers have anti-discrimination protections found in MGL c. 152 section 75(b), Massachusetts’ workers’ compensation law does not expressly prohibit employers from discontinuing benefits, including health benefits, when a worker has taken time off as a result of a work accident.

What if the workers’ comp insurer refuses to cover medical costs?

If your workers’ comp insurer has denied your claim or is refusing to cover any medical costs that are necessary as a result of your work injury, you need to seek legal assistance. Contact The Law Offices of Jeffrey S. Glassman today to schedule a free consultation to learn how we can help.

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