If you are injured on the job in Pennsylvania, you depend on workers’ compensation benefits to take care of your medical expenses. If you have surgery coming up, but your claim is rejected, you may be afraid of the consequences if you can’t cover the costs.
There are options for handling these costs until your claim is appealed and approved. With the help of a reputable attorney, you can understand what happens when your medical bills when workers’ comp is denied.
Table of Contents
What Happens to Medical Bills When Workers’ Comp Is Denied in Pennsylvania?
Most Pennsylvania workers’ compensation claims go smoothly, but if your injury or illness requires extensive care, you could face some roadblocks. Each request for payment is closely examined by insurance adjusters to determine if the treatment is necessary. Anything out of the ordinary can flag your claim for additional scrutiny, which delays payment.
The extra time this requires can mean you risk having to cover your surgery or other treatment by yourself until the expense is approved. However, you do have additional programs you can turn to for assistance.
Medicare and Medicaid Can Help
Medicare and Medicaid are federal health insurance programs that can serve as “second payers” when you are hurt at work. Medicare targets those 65 and older, whereas Medicaid is provided on both the state and federal levels for those under 65 with disabilities or certain medical conditions.
You may qualify for these programs and can apply to receive benefits while you wait for a decision on your workers’ compensation appeal. Since you are often considered disabled from a work injury, you can apply to whichever program applies according to your age.
Private Medical Insurance May Pay
Instead of paying out of your own pocket for upcoming treatment or surgery, you could also turn to your private medical insurance provider to cover the bills. This allows you to get the care you need while you wait for the workers’ compensation company to approve the procedure.
What Happens if My Employer Denies Liability for My Injury Claim?
Your employer owes you a duty of care to provide a safe workplace with protections to avoid accidents and illness. If they fail to do so, you can file a lawsuit to seek workers’ compensation benefits or a jury award to cover your damages from the injury.
Proving liability on the part of your employer can be complex. It’s critical that you follow the recommended procedures for reporting an injury or illness to support your claim for negligence. These steps include:
- Reporting your accident on time
- Seeking medical treatment right away
- Following all your doctors’ orders
- Maintaining communication with your caseworker
- Avoiding activities that would aggravate your injury
You also should never file an injury claim when your condition isn’t covered by the workers’ comp policy. This includes if you were hurt while violating work or safety policies or being intoxicated when the accident happened. You also should not claim benefits by saying an injury occurred at work when it was due to a pre-existing condition.
Filing an Appeal for Workers’ Compensation
In Pennsylvania, you can file an appeal with the Department of Labor and Industry, which oversees the workers’ compensation system for our state. An experienced employment lawyer can assist you with this process to ensure you have the strongest chance of success.
Once your appeal is submitted, you will appear before one or more commissioners for the department and receive a ruling in about 60 days. If your claim is denied, you can then file a motion with the Commonwealth Court of Pennsylvania to review the case and make a decision.
Filing a Lawsuit
If your employer denies liability because they failed to uphold their duty of care for you as an employee, you can file a lawsuit to hold them accountable. You can also file a case against the workers’ compensation company if they are delaying or taking steps to avoid negotiating a fair settlement for your damages.
Pursuing legal action can take time and money, but you don’t have to worry about finding those funds before you can get help from a workers’ compensation attorney. At Krasno Krasno & Onwudinjo, we offer free initial consultations to discuss potential strategies. We also work on a contingency basis, so we don’t get paid unless your case is successful. Our fees are taken as a portion of your settlement, which you review and accept before we begin.
Why You May Need a Workers’ Compensation Lawyer to Get What You Deserve
Even a clear-cut case showing an injury was work-related can run into problems. This is because insurance companies know you are unfamiliar with how the system works, and they will take advantage of you. If you must file a lawsuit against your employer, their workers’ comp insurance provider, or a third party, you can face even more complications.
Instead of trying to navigate any of these processes on your own, you can make things easier on yourself by hiring a Pennsylvania workers’ compensation lawyer. If you are injured, you have to focus on getting better. Dealing with paperwork and underhanded insurance adjusters should not be on your To Do list.
Turning these concerns over to an attorney and their staff means you don’t have to research, investigate, or negotiate the details of your case. A top-notch legal advisor will handle all these jobs for you with the background and knowledge to achieve the best possible outcome. You don’t have to have uncomfortable conversations with insurance adjusters or try to explain your situation. Your workers’ compensation lawyer will do all this on your behalf.
Don’t Take Chances With Workers’ Compensation
If you have been denied medical treatment by your employer or their workers’ compensation insurance company, you need aggressive and skilled legal representation to set things right. Your employer and their workers’ comp provider want to reduce what they owe you, which could mean you are left holding the bill for the treatment you need to recover fully.
Don’t risk losing access to benefits you are entitled to receive. Schedule a free consultation with an experienced workers’ compensation lawyer from Krasno Krasno & Onwudinjo to learn more about your options today.