Can Workers’ Comp Reimburse My Medical Co-Pays?

Workers’ Compensation typically pays doctors and hospitals directly, cutting out any need for injured employees to make co-pays or use their own insurance when seeking medical care.  But not every employee knows about this.  When they get their initial medical care for an injury, they might go to their doctor or to the hospital on their own and make payments as usual.  Can these workers later get these co-pays covered?

In general, Workers’ Comp requires employers to cover all medical bills related to the work injury, including services and co-pays you might have already paid for.  Getting the bills and financial records properly sorted and delivered to the insurance company might be more complicated than when the doctor bills the Workers’ Comp insurance carrier directly, but our lawyers can help you make sure this gets done.  We can also explain how getting medical care outside the system might work in your case.

For a free case analysis, call the Certified Pennsylvania Workers’ Compensation attorneys at Cardamone Law today at (267) 651-7945.

If I Paid for Medical Care Out of Pocket, Can I Get it Reimbursed Through Workers’ Compensation?

Because the Workers’ Compensation laws in Pennsylvania require your employer’s insurance carrier to cover all care related to your work injury, they should pay you back for any care you already received.  There are a few ways it might come up that you already made co-pays to your normal doctor or at the hospital when seeking treatment, all of which should result in reimbursement:

You Didn’t Realize You Had a Work Injury

The typical situation behind the initial treatment for a work injury is that you have an accident at work, you get hurt, and you go to a hospital on your employer’s list of physicians they will cover.  This means that, from the beginning, your work and your employer are attached to the situation, and the initial bills can all be sent to the Workers’ Comp carrier to be paid.  Things are quite different if you get hurt at work but do not notice it right away – or do not notice how bad it is.

Let’s say you were carrying a box and came down hard while walking down a step, and you felt something go, “Pop!”  It might not have hurt that much at the time, but over the weekend, your foot starts hurting, so you decide to see your normal doctor on Monday.  You make an appointment and pay a co-pay for the visit through your own health insurance.  When the facts are all out and you connect that the fracture in your foot was a work injury, you will have to report it to your employer and begin treatment with their chosen doctors, but your initial care should still be covered in many cases.

If you ever have any doubts about whether you were injured at work – or you are not sure if the injury is serious or not – our Pennsylvania Workers’ Compensation lawyers would urge you to report the injury and get treatment from a care provider on your employer’s list of treating physicians.  An employer might be reluctant to let you leave work to go to the doctor, but it is better to treat it as a work injury from the beginning to avoid later problems.

Following this alternate path of seeing your own doctor will give the insurance carrier ammunition to argue that the injury was not work-related because you would have seen an approved doctor if it were.  This means we will need to fight that argument and prove the injury was truly work-related, explaining why you waited to get treatment.

Later Illness or Occupational Disease

In cases where someone develops a work-related illness like cancer, mesothelioma, etc., it might not be immediately obvious to them that their condition is work-related.  In many cases, people will feel sick or run down and go to the doctor, and only after rounds of tests does the doctor diagnose them.

In these cases, like in the situation discussed above, you might have had a lot of medical care already to diagnose and begin treating the condition before you realize it might stem from your previous work with chemicals or dangerous, toxic conditions that might have caused the condition.  Working with a lawyer, you can help show the illness was work-related and file a Workers’ Comp claim for the illness, even if you no longer work at the same job where you were initially exposed.  Typically, these claims have a 300-week window (around 5 years and 9 months) where you can connect a later health condition to earlier exposure at work.

Healthcare During Denied Claims

Not every case sees injured or ill workers getting their medical care covered so easily.  If the Workers’ Comp carrier denies your claim, you might still need medical care quite badly in the meantime.  Getting this care is a priority, and you might need to pay out of pocket or rely on your health insurance to treat you while our lawyers appeal the denial and seek to get back medical bills covered.

Another situation might occur where the Workers’ Comp insurance carrier denies your claim because they simply do not see enough evidence that you have the medical condition you claim to have.  This is common with medical conditions like CRPS (complex regional pain syndrome), where patients often feel painful symptoms that are disproportional to what they should be feeling.  This and other “invisible illnesses” or “invisible disabilities” might need additional medical evidence – meaning additional doctor’s visits – just to prove to the insurance carrier that you are sick or injured in the first place.  Our lawyers can help you include these medical bills as part of your claim and help you find the right doctors to diagnose your condition and provide the medical evidence needed to get your claim accepted.

Contact Our Pennsylvania Workers’ Comp Attorneys Today

If you were hurt at work, call Cardamone Law’s Pennsylvania Workers’ Comp attorneys for a free case evaluation at (267) 651-7945.