Once read a safety slogan saying, “There is a good chance an accident brought you into this world; don’t let one take you out.” This especially relates to workplace accidents. Working in any field, you are prone to accidents if safety is not your first concern. However, many times even after increased safety measures, you get met with an accident, as this is what life is about, facing hurdles and surviving them.
But what worries you more is not the extent of your injuries or how badly the event has impacted you; rather, you are always more concerned about the medical bills that are hanging on your head like a sword, given increased and frequent treatment expenditures. In such a scenario, there is one thing that relieves you of the stress of these medical expenses, which is none other than worker’s compensation benefits. So what is this worker’s compensation, and how it helps you in grave circumstances?
Defining Worker’s Comp
Worker’s compensation is a type of insurance that covers medical expenses in cases where an employee meets with an accident or gets ill while engaging in official work. It is designed to protect workers by providing financial assistance for medical expenses, lost wages, and rehabilitation services resulting from workplace accidents or occupational diseases.
While worker’s compensation rules vary by jurisdiction and country, they are derived from the same principle, which is supporting an employee financially when they become ill or injured due to work-related activities. This insurance offers the following benefits to employees:
- Medical expenses
- Lost wages
- Disability benefits
- Vocational rehabilitation
While you may think that any worker getting ill or injured is entitled to these benefits, we are sorry to burst your bubble, but there are instances when you get denied these advantages regardless of the injury’s circumstances or extent.
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When Worker’s Comp Is Denied – Reasons
But why would a worker be denied this compensation? There are many reasons for this denial which are listed below:
Failure to Report the Injury in a Timely Manner
In many jurisdictions, there is a regulation that requires you to report your accident within a specified time frame; otherwise, your compensation can be dissolved. Hence it is important that you report the happenings promptly to your employer to confirm your compensational benefits.
Lack of Medical Evidence
To acquire medical compensation, it is significant that you provide thorough and complete documentation to the authorities which links your accident to the workplace. Not doing so can cause serious hindrances to your claim.
Pre-existing Conditions or Non-Work-Related Cause
If you have a pre-existing medical condition or your case does not align with work-related factors, you are not entitled to worker’s comp. It is stringently offered to only the victims of injuries and mishappening arising out of or in the course of employment.
Misconduct or Intoxication
If injury or illness is caused while an employee was engaged in misconduct, violating the organization’s regulations, or was under the influence of drugs, then compensational insurance won’t be offered to such employees as well. Intentional and self-inflicted injuries are not covered by worker’s comp.
Other reasons for the rejection of compensation may include disputes over the cause or severity of the injury, failure to meet filing deadlines or procedural requirements, or administrative errors or paperwork issues.
Having getting known all the reasons concerning compensation denial, the main question which arises here is what happens to medical bills when worker’s comp is denied? What an employee needs to get to do in such situations and whether there are any alternatives to deal with the situation or not. Read on to learn about the answer to these queries.
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What Happens To Medical Bills When Worker’s Comp Is Denied? – The Alternatives
In the situation where you, as an employee, have been denied worker’s comp, there are many possible solutions to tackle medical expenses. Some of these are the following:
Apply for Claim Adjustment
If you get the bad news of compensation denial, the foremost step is to apply for a claim adjustment with your state’s Workers’ Compensation Commission (WCC). After the application process, the commission will assign a case number and an arbitrator to your case. The next step is to request a hearing in which you will be able to better explain your case to your employee and the allocated arbitrator. It is advisable that you request an immediate hearing which will grant you a decision within 180 days.
Remember to file the adjustment within three years of your injury and to get the assistance of a professional workplace issues lawyer to have a favorable decision.
File an Appeal
The query ‘What happens to medical bills when worker’s comp is denied’ still stands even after the claim adjustment application, then it’s time to process the appeal. If you believe that you were eligible for worker’s comp, but you have been wrongly denied, you have the right to file an appeal. In this case, keep in mind the regulations and time particularities concerning the appeal process that varies with jurisdictions. Hire an attorney or consult a legal aid organization well-reputed in dealing with worker’s comp issues to better understand the procedure and to enhance success chances and immediately file an appeal.
Health Insurance Coverage
If filing an appeal is not an option, medical expenses must be shouldered by your policy then. In this case, you can always take coverage help from your insurance policy. Send bills to your insurance company and get your expenses settled. However, there is a possibility that this option might also not be viable for you in the condition that your insurance policy does not cover work-related injuries and losses. Hence read your policy benefits thoroughly before choosing this option.
Personal Payment
Lastly, you will have to bear expenses all by yourself if you don’t have health insurance or the one you have does not cover work-related losses. Your savings are the only solution to cover billable healthcare services in such circumstances. You can take a little support by contacting healthcare providers to negotiate bills or to offer you a payment plan.
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THE CORE
The apprehension regarding what happens to medical bills when worker’s comp is denied is understandable given that accidents are a recurrent case in a workplace environment, and frequently paying for such happenings out of your pocket is really a taxing issue considering the highly expensive treatments and a long list of direct and indirect healthcare expenses. So make safety your first concern at your working place and beyond, and if by any chance you get denied your benefits, you can try the above-mentioned options either to adjust the denial or to employ alternatives.