What Happens To Medical Bills When Workers’ Comp Is Denied

Suffering a workplace injury can put you under a whole lot of stress. Thankfully, in most scenarios, you’ll have workers comp to rely on. 

But what if you file for workers comp and get denied?

The good news is that you may have other options. 

Continue reading to learn what happens to medical bills when workers’ comp is denied and the alternative options you can leverage to successfully cover the cost of treatment.

Common Reasons Behind Denied Claims

Workers’ comp is insurance for individuals who suffered workplace injuries that left them unable to work. If your injuries are serious enough to eliminate your earning potential and render you unfit to complete your work duties, you are entitled to receiving workers’ comp benefits.

Still, there are some scenarios where you may be denied.

This usually happens if the injury you suffered is not connected to your regular employment activities. For instance, it could have occurred earlier or while you were traveling to work.

Additionally, if the injury isn’t that severe and doesn’t impede your working ability or warrant medical treatment, chances are the insurance company will deny your claim.

It’s also worth noting that the circumstances in which your injury took place can impact the outcome of your workers’ comp case. For example, if you were not clocked in at the time of the injury, if you were engaged in personal affairs when the injury occurred, or if you got hurt through your own reckless behavior, your claim can get denied. The same applies if you were engaged in criminal behavior at the time of the injury, didn’t report your injury on time, or the injury itself is self-inflicted.     

What You Should Do If Your Claim Gets Denied

To answer what happens to medical bills when workers’ comp is denied is not that easy, because it all depends on what you do afterward.

Not all is lost and you may still recover your benefits if you take advantage of the workers’ compensation appeals process.

We recommend applying for a claim adjustment by filing an appeal with the Workers’ Compensation Commission. Your case will then be assigned a number and an arbitrator, allowing you to request a hearing with your employer in the presence of your case’s arbitrator.

To receive the benefits as fast as possible, you should file a request for an immediate hearing.

There’s a probability that the arbitrator will decide to once again deny your claim, but you can appeal this decision too by filing a petition for a review within 30 days of the previous hearing.

After assessing the decision, the Workers’ Compensation Commission will schedule a new hearing. To strengthen your claim, you can submit a written argument in support of your version of events. 

If your claim is denied, you should hire an attorney specializing in workers’ comp. They can help you put together a stronger case and more importantly, prepare you for the hearing. Your employer will most likely show up to the hearing with an attorney, so there’s no reason why you shouldn’t either.   

Possible Options If Your Claim Ends Up Getting Denied At The Appeal Stage

It’s easy to continue overthinking about what happens to medical bills when workers’ comp is denied. Rest easy as there are alternative avenues you can pursue to cover your medical expenses.

You may not be aware of it but your insurance company might be able to pick up the slack. While they’re not required to pay for your medical treatment if you’re injured at work, when workers’ comp refuses to cover your bills, everything changes. There’s a high probability that your insurance company will cover everything, thus minimizing your out-of-pocket costs.

You should try the following options:

1. Personal or group health insurance

These health insurers will most likely cover your accumulated medical expenses until you resolve your workers’ comp case. 

To make use of this option, you first have to file a dispute notice. Then, you need to agree to pay back the insurer after you receive your settlement by signing a legally binding reimbursement agreement.

You should do this with an experienced attorney present. They can help negotiate a lower repayment rate with the insurance company. 

2. Medicaid or Medicare

For those without personal or group health insurance, there is still hope. You can settle your medical expenses through Medicaid. Keep in mind this is only available to low-earning workers that have limited personal assets.

Although Medicaid beats paying for medical bills out of pocket, there are some downsides you need to be aware of. For starters, Medicaid has very low rates, meaning you’ll receive a lower-quality treatment.

Many medical providers also don’t accept it, so you might spend a large amount of time finding someone who will provide you with the treatment you need.

On the other hand, Medicare makes it easier to find a medical provider but you must be at least 65 to qualify. However, if you are approved for disability benefits, you can receive Medicare without meeting the age requirements. If you think you can apply for it, act quickly as it will be available for only 29 months following the injury. 

Don’t Go Through The Process Alone

It’s no secret that navigating the workers’ comp is a significant challenge and often overwhelming for a person to handle. You can erase a great deal of uncertainty and stress from the entire process by hiring an attorney. 

Having a legal professional on your side from the very beginning means you won’t only feel more comfortable, but also have full insight into all your legal options and rights. This can ultimately help you achieve the best possible outcome.

For quality assistance, reach out to Law Offices of RITE - our attorneys have decades of experience in handling the most complex types of workers’ comp cases and can help you attain the maximum every step of the way. 

Call (904) 500-RITE (7483) or send a message to info@rite4justice.com to schedule a free case review.

Note: 

The information in this blog post is for reference only and not legal advice. As such, you should not make legal decisions based on the information in this blog post. Moreover, there is no lawyer-client relationship resulting from this blog post, nor should any such relationship be implied. If you need legal counsel, please consult a lawyer licensed to practice in your jurisdiction.