Medical Benefits After An Injury
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Prompt medical treatment after a personal injury or work injury can optimize your physical, emotional, and financial recovery. Under the Workers’ Compensation Act, your employer is required to pay for all medical care that is reasonably necessary when a workplace accident or exposure causes you to be injured. Despite the law, many employers and insurance companies routinely deny or delay medical benefits when workers are hurt. They refuse to authorize diagnostic procedures, deny claims, and use various strategies that delay treatment. With personal injuries, sometimes you have to pay out of pocket to get treatment for something that wasn’t your fault. Our partners don’t require any payment until your case is settled.
What Medical Expenses Are Covered?
Most types of medical care that may be required after a workplace accident are covered by workers’ compensation insurance. This includes ambulance costs, emergency room visits, physician and hospital care, diagnostic testing, and surgery. If you see a chiropractor, physical therapist, or other specialist, your treatment should also be covered.
Additionally, prescription medications, prosthetic devices, and prescribed medical equipment and supplies are covered. Wheelchairs, shoe lifts, and even modifications to your home may be covered as well.
Choosing Medical Providers
It’s important to choose your medical providers carefully after a work-related injury. If your employer has established a Preferred Provider Program (PPP), you may be restricted to certain doctors and hospitals for nonemergency care.
Additionally, injured workers in Illinois are limited to two providers. If a PPP is applicable, those two providers must be “in network”. If there is no PPP, the worker can choose any two providers. First aid, nonemergency care, and treatment that is sought before the injury is reported does not count toward the number of providers a worker may see.
How the Utilization Review Might Apply to Your Workers’ Comp Case
Employers have a right to evaluate the necessity of your medical treatment after a work injury. By performing a “utilization review”, employers may review all past, present, and expected future medical treatments and determine their necessity. Findings from the review may be brought before the Commission if the employer wishes to challenge certain treatments. To determine whether a treatment is reasonably necessary, the Commission will review all evidence including the employer’s finding. Treatments that are determined to be excessive or unnecessary may not be covered under the Workers’ Compensation Act.
Getting Help with Your Medical Benefits After a Work Injury
At Eames Law Group, we take prompt action to ensure that you have access to the medical treatment you need after a workplace injury. If your employer refuses to authorize medical treatment, or your request for payment of medical bills has been delayed or denied, our firm will bring your case to the Illinois Workers’ Compensation Commission for arbitration. We’ll request a 19B Emergency Hearing to resolve authorization or payment issues fast so you can continue to heal.
Hearings under 19B allow attorneys to expedite the process and can give your claim priority over all the other claims which are pending before the Arbitrator. The arbitrator can then order your employer to authorize medical care and pay for the treatment, tests, or special equipment you need.
Need Help With Your Case?
Attorney Brent Eames is a compassionate advocate for his clients and is experienced in securing top verdicts, awards, and settlements on behalf of injured workers and accident victims.
Before you talk to anyone, you should call our office and schedule a free consultation with our experienced lawyer to determine your rights and to ensure that you set up for case to receive the maximum compensation which you may be entitled to under law.