Getting successful medical treatment is usually your number one priority after a workplace injury. The following article will give you a good idea of what medical expenses will be covered by workers’ comp benefits and which ones will not. Knowing what will be covered ahead of time will help prevent you from getting stuck with expensive medical bills.
Seek Medical Treatment Through the Proper Channels
If you are injured on the job, you should seek treatment as soon as possible. Seeking treatment quickly is important because it can make it harder for your employer or its insurance company to argue later that your injury was not work related or that you were not injured at all.
Find out whether your state requires you to see a certain doctor. If it does, make sure you see one of the approved doctors. The insurance company may not be required to pay for treatment you receive from a non-approved doctor. Getting treatment quickly from the right doctors will help ensure that you get the treatment you need through the workers’ comp system.
If your injury requires immediate attention, you are allowed to go to the nearest emergency room, and the cost will be covered by workers' comp (assuming your claim is accepted). But once you leave the emergency room, you're required to continue medical care with a doctor approved by your insurance company (if your state requires you to see a certain doctor). (For more information, see Can I Choose My Own Treating Doctor in My Workers' Compensation Case?)
Treatments Commonly Covered by Workers’ Comp
For any type of medical treatment to be covered, it must be recommended by your doctor and be proper and necessary to treat your work-related injury or illness. Diagnostic tests such as x-rays, MRI’s, CT scans, or ultrasounds are usually covered if they are necessary to successfully diagnose your workplace injury.
Once your injury is diagnosed, medical bills related to treatment of your injury are also covered by your employer’s workers’ comp insurance company. Covered treatment includes doctors visits, medications, surgeries, and hospitalizations. If you need a wheelchair or other adaptive device, that will be covered too. If you have to travel to your doctors’ appointments, you may also get reimbursed for your mileage or transportation costs.
Treatments Not Usually Covered by Workers’ Comp
Although workers’ comp benefits are available for a large variety of medical treatments, there are some treatments that are not usually covered. Experimental treatments and drugs are usually not covered by workers’ comp. However, you may be able to participate in medical trials where the entity conducting the trial will partially or totally cover the cost of experimental treatments.
Acupuncture and other alternative medical therapies are often not covered by workers’ comp. However, some states, such as California, do offer coverage for acupuncture therapy in certain types of cases.
Workers’ comp will not cover any medical treatments that your doctor believes are unnecessary to treat your work-related injury. The insurance company will also deny claims for treatment of injuries or illnesses that are separate from your work-related injury, even if those services are performed by the same doctor.
Physical and Vocational Rehabilitation
If you need physical rehab to fully recover from your injury, the expense is likely covered. Rehab could include occupational therapy, physical therapy, chiropractic care, or massage therapy. While these things are covered expenses in most states, there may be a limit to the number of treatments you can be reimbursed for. For example, California limits workers to 24 physical therapy, 24 chiropractic, and 24 occupational therapy visits.
If your injury prevents you from working in the field you worked in prior to your injury, in some states you may also be eligible to receive vocational rehabilitation benefits. Vocational rehabilitation includes a wide range of services from job training to counseling. In California, vocational rehabilitation is now called the "supplemental job displacement" benefits, which consists of a voucher of up to $6,000 that can be used for education, training, job counseling, certifications, or computer equipment. (To learn more, see our article on vocational rehabilitation benefits in workers' comp.)