Anyone with health insurance has been at the point where they go to a new doctor only to find out that doctor doesn’t accept your insurance. It’s frustrating and, at times, expensive. Unfortunately, it’s a frequent occurrence and is why it’s important to always research doctors and specialists before setting up an appointment to make sure your health insurance will cover you.
But what about when you have workers compensation to cover your injury expenses? Does your doctor have to accept it, or can they reject it just like health insurance?
Health Insurance vs Workers Compensation
First, health insurance and workers compensation are vastly different. Workers compensation is a policy held by your employer that is designed to cover your medical expenses related to a work injury. If you break your ankle from a fall at work, for example, workers compensation will help pay for the medical exams and treatments related to the broken ankle and may cover lost wages if you are unable to return to work until the ankle is healed.
That being said, workers compensation only covers expenses related to your workplace injury. If you injured your ankle and later go to your doctor for a regular checkup or refill unrelated medication, those expenses will not be covered under workers compensation. Instead, you will need to have health insurance or otherwise pay for unrelated expenses out of pocket.
The same principals apply even if you purchase your health insurance through your employer. Workplace injuries and related expenses should be handled under workers compensation insurance. Going back to the ankle injury, say you choose not to file a workers compensation claim and instead use your health insurance to cover most of your expenses. But your health insurance doesn’t cover all of the antibiotics you are given or the physical therapy as your ankle heals. On top of that, you are out of work and have to take sick time or paid leave, without the wage replacement offered by workers compensation.
These two policies are similar but different, and both critical to take advantage of. Any time you are injured at work, you should notify your manager and file a workers compensation claim.
Employer Approved Health Professionals
So, is your doctor required to accept your workers compensation as payment? Or can they refuse it and make you pay out of pocket?
It’s important to note that many employers’ workers compensation policies have approved health professionals, doctors and facilities. If your doctor is not listed as an approved source, you may not be able to use your workers compensation benefits there. In the case of a workers compensation claim, you are generally required to go to a doctor that is approved on the policy in order to receive all of your workers compensation benefits. If you refuse to go to an approved medical professional or otherwise fail to seek immediate treatment, any other workers compensation benefits could be denied.
When you visit a health provider that is approved by your employer’s policy, they must accept workers compensation up to your limits and only in regard to your work-related injury. Even if you go to an approved doctor, you cannot use workers compensation benefits for any exams or services that are not related to the injury you sustained at work.
What Should You Not Tell a Workers Compensation Doctor?
When you do see a doctor, it is critical to be honest. Being honest about the nature of your injury can help you get the proper care you need. You should also be honest about your medical history and any preexisting conditions that could be affected by your injury.
Not only can lying prevent you from getting the proper medical treatment, but it can also lead to accusations of fraud and the denial of your workers compensation benefits. The workers compensation provider and the approved medical professional generally work in close proximity to ensure that the injuries you are being treated for are from the workplace accident. As you get better, your doctor will notify the workers compensation provider. This is also how they decide when you are approved to be back to work and how long your wage replacement or disability benefits will last.
If you are permanently disabled, either partially or totally, and are no longer able to work because of a work-related accident, you may be entitled to lifelong compensation or compensation for training in a new field. No matter what happens, make sure to keep your doctor updated on any flareups or pain you may experience later on even after the old injury is healed.
Also Read: Do You Get Full Pay for Workers Compensation?