Workers’ Compensation medical benefits pay for costs incurred in treating a work-related injury or illness. In general, a Pennsylvania employer has an obligation to provide Workers’ Compensation insurance coverage for medical benefits for all medical tests, treatments, medications, and equipment necessary for the employee’s recuperation or rehabilitation. Just as the appropriate medical care for your injuries is vital to your full physical recovery, establishing a clear, comprehensive record of your medical treatment is essential to maximizing your Workers’ Compensation benefits. With this goal in mind, Philadelphia workplace injury lawyers at E.S. Borjeson & Associates work diligently to ensure that our clients progress through the maze of healthcare services and the piles of medical documents and bills with as much ease as possible.
When you or someone you love is injured on the job in Pennsylvania, it is imperative that you follow the claims procedure carefully. Failure to do so could result in denial of benefits. Pennsylvania law allows a person 120 days to report a work-related injury, but seeing a physician and notifying your employer as soon as possible is your best option when you need Workers’ Compensation medical benefits coverage. After an accident at work, reporting any injuries to your employer quickly will help substantiate that the condition is related to the work accident or incident. Likewise, seeking medical care soon thereafter will corroborate this claim.
Once a Workers’ Compensation claim is accepted by an employer, the employer can require the injured worker to consult with a specified physician if: 1) the employer has posted a list of at least six physicians for the injured worker to choose from, and 2) the worker has signed two acknowledgments of this obligation to see one of the physicians on the list. If your employer has failed to meet these requirements, your employer must pay for all reasonable and necessary treatment by a healthcare provider of your choosing. However, if the list of specific physicians was provided and you signed the required acknowledgments, you must see a doctor on the list for the first 90 days of your treatment. After the first 90 days, you may see a doctor of your choice.
Under the Pennsylvania Workers’ Compensation Act, eligible employees who have been injured on the job or suffer a work-related illness or disease are entitled to coverage for the following medical interventions:
Emergency room, hospitalization and doctor visits
Surgery and rehabilitation therapy
Medications and medical equipment, including wheelchairs, walkers, and canes
Modifications to your home or vehicle to accommodate your injury
Home nursing care, either temporary or permanent
Workers’ Compensation medical benefits cover 100% of the cost of medical care, without any cost to the injured employee. Therefore, once your claim is accepted, your employer can not refuse to pay for reasonable and necessary treatment related to your work injury.
If the employer disputes your medical expenses, challenging whether they are reasonable, necessary, and/or related to a work injury, the employer will file a Utilization Review Request with the Pennsylvania Bureau of Workers’ Compensation. This Request is assigned by the Bureau to a specialist in the same area of medicine who reviews the treatment and determines whether the challenged treatment is reasonable or necessary for the particular work injury or illness. Either party can appeal the outcome of the Utilization Review and file for a hearing before a Judge.
The establishment of a detailed record of your medical condition and treatment will support your claim for medical benefits. Clearly-documented physician examinations and diagnoses, diagnostic tests results, medical and rehabilitative treatment, and medication information are crucial. If your employer challenges your injuries, your Philadelphia workers’ compensation lawyer will use your medical records to help prove the cause, extent, severity, and duration of your medical condition. Utilization Reviews are complex and strict compliance with procedures and filing deadlines is necessary. An experienced, knowledgeable Workers’ Compensation attorney at your side is imperative.
If you or someone you love has suffered a work-related injury or illness, Philadelphia Workers’ Compensation lawyer Eric Borjeson at E. S. Borjeson & Associates can help you claim the medical benefits you are entitled to under the law. Call us or contact us online to see how our Philadelphia work injury lawyers can help you. We are conveniently located in Center City Philadelphia and serve clients throughout Southeast Pennsylvania, including Bucks County, Delaware County, Chester County, Montgomery County, and Berks County.