What Happens to My Medical Bills After My Workers’ Comp Claim Is Denied?

Handling Unpaid Bills Is Complicated

When and how medical bills are paid can be very complicated and depend on the unique circumstances of your case. A free consultation with a workers’ comp lawyer is suggested in these circumstances. Below are some general points to understand.

Seek Reimbursement for Past Due Bills

Requesting a formal hearing is not a way to pay bills now, but it’s how you ultimately get the bills taken care of. If you settle your case, the workers’ comp insurer may be required to cover the medical bills related to your injury (depending on the settlement terms), including reimbursing you for out-of-pocket expenses that should have been covered. If you succeed at the hearing, Georgia law holds employers and insurers accountable for medical costs if a denial is overturned or found wrongful – they can be ordered to pay all medical bills related to the injury and reimburse any expenses you shouldered. So, while this doesn’t help you pay the bills in the short term, know that part of your fight on appeal will be to get these medical costs paid. If you keep receipts and documentation, you can recoup a lot of those costs later if you succeed in your claim.

Past Due Bills for Emergency Care

If you have received emergency care for your work-related injury, you may have substantial medical bills piling up. You have a right to seek reimbursement for these costs by requesting a hearing with the State Board of Workers’ Compensation. This process can take time. It could take six months to a year (or even longer) for a Judge to hear your case and issue a decision. In the meantime, you may be receiving collection notices or calls from the hospital or medical provider demanding payment. Unfortunely, this is a tough situation, especially if you did not have health insurance. If you are facing unpaid medical bills, you should not wait to contact a workers’ comp attorney. You need to take action as soon as possible to get the reimbursement process started.

Who Is Responsible for Future Medical Bills After a Denied Claim? (and what to do about it)

Medical providers may start billing you directly for services related to your injury once they know workers’ comp has denied the claim. You are technically liable for these bills. One of the most pressing issues after a claim denial is how to handle medical expenses. Under Georgia workers’ compensation, when a claim is accepted, the insurer covers all authorized treatment costs (100 percent with no co-pay). Once the employer/insurer controverts (denies) the claim, you become responsible for paying your medical bills, at least for the time being.

If your have health insurance, your insurance may become the primary payer for your medical expenses (after you proved the injury was denied by workers’ comp). If your health insurance pays and the treatment is later found (by a judge) to be work related, the workers comp insurance may be ordered to repay your health insurance carrier. But even with health insurance, you will still be responsible for co-pays, deductibles, and any non-covered services. This can be a significant financial burden, especially if your injury requires ongoing treatment or surgery. If you win a workers comp hearing, the judge will order the workers’ comp insurance to reimburse your health insurance for your out of pocket expenses.

Likewise, if you have Medicare or Medicaid, they may cover some of your medical expenses, but you will still be responsible for any co-pays or deductibles. When Medicare pays for something workers’ comp should have paid for, it is called a “conditional payment.” Medicare and Medicaid may also seek reimbursement from the workers’ comp insurer for conditional payments. This is called subrogation, and it means that if you win your case, the workers’ comp insurer may have to reimburse Medicare or Medicaid for any medical expenses they covered. Even if you do not go to court, but settle your case, the workers’ comp insurer may be required to reimburse Medicare or Medicaid (out of the settlement) for any medical expenses they covered.

If you don’t have health insurance or your policy excludes work injuries, you may be left with the burden of paying out-of-pocket for treatment. This situation puts injured workers in a tough spot. You likely still need medical care for your injury, but now you might receive bills for doctor visits, hospital treatment, or therapy that workers’ comp would have covered if the claim was approved. There are some doctors who may agree to treat you on a lien basis, meaning they will provide care now with the understanding that they will be paid from your settlement or award later. However, not all providers will agree to this arrangement, and it can be difficult to find doctors willing to treat you without upfront payment.

Important note: Health insurance and Medicare/Medicaid will not pay for treatment if they know it is a work-related injury. You would need a formal denial from the workers’ comp insurer before they would pay (saying the injury is not work related). If the workers comp insurer only says the treatment is not medically necessary, that would not make your health insurance or medicare the primary coverage. You would need to appeal the denial to the State Board of Workers’ Compensation.

When a treatment isn’t technically denied, but workers’ comp is not authorizing it

Although “pre-authorization” is not required by Georgia law, it is a common practice in the workers’ comp system. Most doctors will not treat you unless the insurance company has authorized the treatment.

In cases where the injury is accepted, but the insurance company is not timely authorizing treatment, your attorney can file a “WC-PMT”. This is a petition for medical treatment. The WC-PMT is a formal request to the State Board of Workers’ Compensation to order the insurance company to pay for the treatment. The WC-PMT process is an expediated process, and will force the insurance company to either authorize or deny the treatment. The whole process only takes about a week or two.

Don’t Face a Denial Alone – Contact Our Cumming Workers’ Comp Attorneys for Help

Don’t let medical bills pile up and legal deadlines pass. Contact the Bourne Law Firm today for a free consultation about your case. We will review the details of your claim denial, explain your options, and help you form a plan to get your medical bills paid and your claim back on track. Our team is committed to protecting Georgia workers. Let us put our experience to work for you so you can focus on healing.

Call Bourne Law Firm today to discuss your denied workers’ comp claim. We’ll fight to protect your rights, handle the legal complexities, and work tirelessly to ensure you are not stuck with the costs of a workplace injury that should be covered.