Medical Bills When a Workers’ Comp Claim is Denied: What Happens Now?

Free Case Evaluation
100% Secure and Confidential
Google Rated

Workers’ compensation coverage is supposed to pay for the costs of caring for your work-related injuries. However, you need an insurance company to sign off on the claim and grant benefits before they begin to pay.

If the insurance company denies your claim, you may have considerable difficulty paying for your care in the meantime. Nonetheless, it does not mean that you will not get the care that you need when you need it. An experienced workers’ compensation attorney in Wilmington, NC at Horton & Mendez can help you navigate this difficult situation.

Why Workers’ Compensation Claims Are Denied

The insurance company can deny your workers’ compensation claim for a number of reasons, including:

  • You supposedly did not meet some of the administrative requirements, including timely notifying your employer of your injury.
  • They believe that any injury that you suffered was not related to your job.
  • They claim that you are not injured in the first place.

You Are the Responsible Party to Pay Your Bills

People may not realize the difficult situation that they are in until their claim is actually denied. When they visit the emergency room, they simply expect that the medical treatment will be covered. Then, they are in shock when they receive the actual bill and a due date for payment.

Whenever you receive medical care, you are the one with the ultimate responsibility to pay for the services that you have received. You would have signed an agreement with the medical provider that makes you ultimately responsible for covering the bills no matter what happens. This is a binding contract that you would need to follow, even if your claim was denied.

You Have Other Options to Pay Medical Bills if Your Workers’ Comp Claim Is Denied

Having said that, you have alternatives if the workers’ compensation insurance company has initially denied your claim. Of course, you can file an appeal and potentially get benefits in the future, but that prospect is of little help to you right now.

If you have group or personal health insurance coverage, the insurance company may cover your bills in the interim. Usually, health insurance companies do not cover bills for work-related injuries. However, if your workers’ compensation claim has been denied, the health insurance company may pay for these bills pursuant to a “Notice of Dispute.”

Using Medicaid or Medicare to Pay for Your Medical Bills

Medicaid is one option that can help you pay for your medical bills, until your injury is completely healed, or you can win an appeal. However, Medicaid is only available to people below a certain income threshold.

In addition, you may not have assets that exceed a certain threshold to qualify for Medicaid. While Medicaid may not provide you access to all the care that you need, it is certainly a way of giving you some medical help.

Unfortunately, some medical providers do not accept Medicaid. If you do eventually reach a workers’ compensation settlement, you would need to reimburse Medicaid for the money that it has already spent on your claim.

There are limited instances in which you may qualify for Medicare. Then, the government would be the insurer that pays your bills, subject to many of the same rules as Medicaid. Medicare would also have a lien and be entitled to reimbursement when you get your settlement.

Some Doctors Will Work With You Until Your Matter Is Resolved

If you do not have any other options, you may be able to negotiate with the healthcare provider. Some doctors understand that it is better to accept some of the bill, rather than to continue to pursue you. They would understand that they could end up with nothing if you end up in bankruptcy. Then, the Chapter 7 process could get you out of medical debt completely.

Some doctors will let you defer payment until your workers’ compensation appeal is resolved completely. They also have their own interests in being flexible. Then, the doctor would be entitled to payment when you do receive workers’ compensation benefits. Your settlement would reflect the bills that you have already incurred for medical care.

Consider Hiring a Lawyer When You Have Filed a Claim

There is no question that a claim denial will present you with serious challenges, both physically and financially. Your goal should be to avoid a denial in the first place.

While not everything is under your control, you can present the strongest possible claim for benefits to the insurance company in the first place. When you can offer compelling evidence that you have suffered a work-related injury, you are in a better position to get the benefits that you need.

You should consider hiring an attorney for any workers’ compensation case.

You should retain counsel if you think that your claim could be challenging in any way — such as when you are dealing with an injury that could be considered “subjective,” and the insurance company may deny your claim for supposed lack of proof.

An attorney could also help you deal with the challenges surrounding your medical care. They could give you advice on the options for obtaining possible medical care while you are pursuing your appeal. Your lawyer could help you file an appeal that can help you overturn any wrongful denial of your benefits.

It isn’t ideal to approach a lawyer for the first time after your claim is denied, but you should get a consultation in any case.

Contact a Wilmington Workers’ Compensation Attorney Today

If you need legal assistance with your workers’ compensation claim, the attorneys at Horton & Mendez are in your corner. We work with injured workers to both help get them the benefits that they deserve and to help them deal with what could be a difficult process.

Claimants can reach out to one of our attorneys to get assistance. You can send us a message online, or you can call us today at 910-405-7751 to discuss your case with a qualified professional.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
100% Secure and Confidential