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According to the National Safety Council, there were 4.53 million work-related injuries in 2022. Workers’ compensation insurance provides a few benefits to those who have been injured on the job.
When workers have been injured and cannot work, medical benefits can help them get the treatment they need. These entitlements cover the cost of necessary medical treatment, such as doctor visits, surgeries, medications, and rehabilitation care.
However, the type of coverage can vary by state. These variations in workers’ compensation laws may affect the types of medical treatments covered and the process for filing claims.
If you would like to learn about workers’ compensation medical benefits and what they cover, here is a general look at possible coverage you may be entitled to.
Are You Eligible for Benefits?
According to the Occupational Safety and Health Administration (OSHA), an injury or illness is considered work-related if an event or exposure in the work environment caused or contributed to the resulting condition or aggravated a pre-existing injury or disease.
In other words, if you were performing a task for your employer’s benefit and you were injured or became ill as a result, then your injury or illness is considered work-related. With that, you may be eligible for workers’ compensation benefits. These benefits include medical care and wage replacement.
In most cases, workers’ compensation benefits are available to various types of workers, such as:
- Full-time employees
- Part-time employees
- Seasonal workers
- Temporary workers
While there could be exceptions in some states, independent contractors and volunteers are excluded from workers’ compensation benefits. If you would like to learn more about collecting these benefits after getting hurt on the job, contact your local workers’ compensation board or an attorney who handles workplace injury cases.
Medical Treatment Coverage
When it comes to workers’ compensation, injured workers are covered for their medical care, as long as it is related to the work injury or illness. Some of these covered expenses can include:
Doctor Visits
After you have been injured, you will need to visit an authorized healthcare provider. These professionals will diagnose and treat job-related illnesses and injuries. Injured workers have the right to seek medical attention right away. An employer should never prevent or deny your right to get help. Whether it’s a minor sprain or a more severe condition, these visits are covered under workers’ compensation coverage.
Hospital Stays
Sometimes, the injury or illness is so severe that a stay in the hospital is necessary. In these events, workers’ compensation covers the costs. Injured employees can rest assured that their hospital expenses are part of the coverage, whether due to a workplace accident, surgery, or other medical emergencies.
Surgeries and Other Medical Procedures
Some on-the-job injuries or illnesses would require surgical intervention. If you have been hurt and need treatment, these costs will be covered under the insurance policy. Many times, these necessary treatments are needed to get you back on the job.
Medications
Prescribed medications are also reimbursed under workers’ compensation. Injured employees can receive pain management prescriptions, antibiotics, or other drugs to help in their healing process.
Physical Therapy and Rehabilitation
After treating the initial injury, you may need additional medical support to return to the job. Workers often need physical therapy and rehabilitation services to regain strength, mobility, and function. Workers’ compensation ensures access to post-surgery rehabilitation or ongoing therapy.
Remember, workers’ compensation helps you get back on the job. If you need to learn more about the specific benefits offered in your state, reach out to your local agency.
How Do I Claim These Medical Benefits If I Was Hurt on the Job?
If you have sustained a work-related injury or illness, you will need to follow specific steps to get access to your entitled workers’ compensation medical benefits.
- Report the incident: You should immediately report the incident to your employer. This will trigger the workers’ compensation process and document the details of the injury or illness, including the date, time, and circumstances.
- Medical examination: After reporting the incident, you will want to undergo a medical examination by a healthcare provider. Not only will it get the right treatment, but it also confirms that the injury or illness is work-related.
- Filing the claim: After that, you will need to complete the necessary claim forms. By doing this, you can formally file the workers’ compensation claim with your employer’s insurance or state agency.
- Wait for a decision: in most cases, your claim will be approved or denied. With approval, you will receive your medical care and wage replacement benefits. However, you have the right to appeal the decision if there is a denial.
What Happens If Your Claim Has Been Denied?
You can still collect medical care benefits if your claim has been denied. First, you will want to review the denial letter. You will have reason for the denial, which could include missing deadlines, insufficient evidence, or other issues.
After that, you may want to seek legal advice from an experienced workers’ compensation attorney. They can assess your case, explain your rights, and guide you through appeals.
Most states allow you to appeal a denied claim. Follow the specific procedures outlined in the denial letter. You may need to collect additional evidence to support your claim, such as medical records, witness statements, and other documentation types.
Many times, you may need to attend hearings or mediation sessions to present your case. You need to be prepared to explain why your claim should be approved and address any concerns the insurer raises.
Workers’ compensation medical benefits help support injured workers and get them the necessary medical care. Remember, these benefits are designed to protect you and provide some peace of mind during challenging times.