When a work injury occurs, medical expenses quickly add up. The National Safety Council reports that the average cost of job-related motor vehicle accidents was $85,311, fall and slip injuries averaged $48,575, and the average cost for injuries caused by a person caught by or in machinery was $44,588. Workers’ compensation benefits generally pay the costs associated with the medical treatment an injured worker needs but not always.
Sometimes, an insurance company handling a workers’ compensation claim refuses to pay all or some of the medical expenses incurred by a worker. It could be because the insurer determined that an injury was unrelated to work, or it may decide the treatment was unnecessary.
If you are injured at work, you need to know what options are available for payment of your medical bills. This article explores workers’ compensation insurance and other payment options available to avoid financial hardship from medical expenses after a work injury.
Workers’ compensation insurance
Workers’ compensation systems exist to pay medical expenses and lost wages of workers injured or sick because of work-related accidents and conditions. In return for paying the cost of a workers’ compensation insurance policy covering their employees, state workers’ compensation laws prevent employees from suing employers for work-related injuries and illnesses.
If the insurer approves a claim for benefits, all medical expenses for the treatment and care of a worker are paid. However, some states allow insurance companies to deny benefits under the following circumstances:
- Injuries caused by a claimant’s use of alcohol or drugs.
- Worker obtains medical treatment from a provider not approved by the insurance company.
- Medical care for treatment of an injury or illness that was not work-related.
A denial of a claim can be for something other than a medical bill from a doctor, hospital or pharmacy. For example, a doctor may suggest the use of compression socks for leg swelling, but if the swelling is not because of a work injury or illness, the claim will be denied. A worker has the right to appeal a denial of a claim, but if the denial is upheld, then another source of payment must be found.
Health Insurance
A health insurance policy offers an option to pay medical bills that workers’ compensation does not pay. It’s important to note that the company providing health insurance coverage may require an agreement from its insured to repay the company if a workers’ compensation claim for benefits is approved.
Health insurance plans usually require payment of deductibles and co-pays for claims that you submit. Your out-of-pocket cost could be significant. Use your health insurance only while appealing the denial of workers’ compensation or an appeal has been lost.
Medicaid
Medicaid is a federally funded program that pays medical expenses for people who meet its eligibility requirements. States administer Medicaid programs and set eligibility standards, including having limited income and assets.
You cannot keep any money that you get from workers’ compensation for medical expenses that Medicaid paid. Medicaid will demand reimbursement from you.
Third-party claims
Workers generally give up their right to sue their employers for job-related injuries, but that does not extend to third parties. For example, if a delivery truck owned and operated by someone other than your employer hits you while you’re at work, you may have a claim against the driver whose negligence caused the accident.
A claim against a third party based on negligence would be in addition to your workers’ compensation claim. The workers’ compensation insurance company has the right to be reimbursed for any benefits it pays you that were included in the damages awarded to you in the settlement of your case against the third party.
Disability Insurance
If workers’ compensation insurance is not available to you for a work injury, money to pay medical bills or other expenses may be available from disability insurance. Only a few states have disability insurance programs, but you may have coverage through a short- or long-term disability insurance policy provided by your employer or that you purchased.
You use the money from either a state disability program or from a policy of disability insurance to pay expenses while out of work. Use the disability payments for any expense that arises, including medical bills.
Lawsuit loans
When a work injury leaves you with a disability, you may be entitled to a lump-sum settlement from workers’ compensation, but it can take a long time to get it. While waiting, you can apply to a funding company for a lawsuit loan.
The funding company evaluates the likelihood of a settlement and its value. It then offers you a portion of the value as a lawsuit loan. The company receives repayment of the money it advances plus the interest it charges you only from the settlement.
Unlike a traditional bank loan that obligates you to repay the debt, a lawsuit loan does not personally obligate you to repay it. It gets repaid only from the anticipated settlement.
Lawsuit loans are popular with people needing immediate access to money from a pending lawsuit settlement. If you have a third-party claim pending from a work injury, a lawsuit loan may help to pay medical bills.
Conclusion
Don’t allow unpaid medical bills from a work injury to cause financial distress. One or more options discussed in this article may be available to pay medical and other bills piling up because of an injury at work.
