Coverage for medical expenses is one of the main benefits of workers' compensation insurance. However, don't expect coverage for all your medical costs if you are injured on the job. Here are some of the reasons workers' compensation may not cover some treatments:
It's an Alternative Treatment
The medical benefits are meant for standard treatment techniques, also referred to as Western medicine. Therefore, the insurer may deny your claim if you are getting an alternative treatment, such as naturopathic medicine (treatment methods that promote self-healing). It doesn't mean you are barred from getting alternative forms of treatments, and in some cases you may even be compensated for them, but don't rely on it as you would on compensation for standard treatments.
It's an Experimental Treatment
Not all forms of western medicine are acceptable as far as workers' compensation is concerned. You will only be compensated for treatments that have been approved by the relevant authorities. If you are undergoing an experimental form of surgery or taking experimental drugs, expect to foot the bill out of your pocket. This is even more likely if there is an acceptable standard treatment regimen for your injury.
Treatments for Injuries or Conditions Unrelated to Your Injury
When seeking treatment after a workplace injury, there is a chance the doctor may discover other health issues unrelated to your injury. You will have to take care of these issues too, but don't expect workers' compensation to cater for those treatments. Consider a situation in which you are being treated for a fractured leg, and the orthopedic discovers a tumor on your leg. Workers' compensation will not pay for the tumor's diagnosis or any subsequent treatments it may need.
You Have Reached the Limit on Treatment Sessions
Some forms of treatments require multiple sessions. For example, you may need multiple physiotherapeutic sessions if you have a musculoskeletal injury. However, for some forms of therapy, workers' compensation insurers often limit the number of treatment sessions injured employees may have. For example, in California, all workers who got injured in 2004 or later are limited to 24 sessions of physiotherapy. In such situations, you may be required to pay for any subsequent sessions above the acceptable limits.
These are general restrictions; the insurer will examine the unique situations of your case before making a decision. In some cases, you can talk to the insurance company to treat your case as an exception. For example, in the case of limited treatment sessions, your physician may convince the insurer that further treatment sessions will improve your recovery. If you've been injured on the job and are looking for compensation, consider hiring a lawyer, such as Freedman, Wagner, Tabakman & Weiss, to take on your case and get you the compensation you're entitled to.
Share