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Medical Treatment for a Denied Work Injury Claim

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Medical treatment will be at your expense if worker’s compensation denies your work injury claim.

Your options are to:

  1. Pay out of your own pocket, OR
  2. File with private health insurance

Keep accurate records of the expenses you accumulate for treatment related to your work injury because this information will be needed if you contest the denial of your claim. If your private health insurance pays for your medical treatment and you end up being awarded worker’s compensation benefits, then your health insurance company should be reimbursed by the worker’s compensation insurance carrier. Make sure this issue is addressed before signing the final settlement agreement. Otherwise, you may be responsible for reimbursing your private health insurance out of your settlement money.

If you do contest the fact that your claim was denied by your employer’s insurance carrier, and you file an Application for Adjustment of Claim (AAC) with the Worker’s Compensation Board, then medical providers who have treated your work injury cannot try to collect payment from you until it is determined who– either you or your employer’s insurance carrier– is responsible to pay. In order for medical providers to be considered for payment when the Board determines who is responsible to pay for your medical treatment, the provider should file an Application for Adjustment of Claim for Provider Fee (Form 18487) with the Board. An Ombudsman can assist with completing this form.

This rule only applies to those who treat you for the work injury. So, if your credit card company is coming after you for not making the required payments, even if the reason  you cannot make these payments is because you are not working now as a result of your work accident, you will not be protected by your worker’s compensation case. Similarly, if you have a collector calling you about a dental bill that is unrelated to your work accident, there is nothing you can do about it through your worker’s compensation case.

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