Who Pays the Medical Bills After a Work Injury?
After a work related injury, the injured worker’s bills start piling up. This can be a very stressful time. Recovering from a serious work related injury is difficult. It can become even more worrisome when the medical bills start piling up.
Generally, the employer is responsible for maintaining worker’s compensation insurance. Part of the worker’s compensation insurance coverage is for the payment of medical bills. If the worker’s compensation insurance company accepts the injured worker’s claim as payable, that company will make arrangements for the payment of the medical bills on behalf of the injured employee.
But, the injured employee shouldn’t take this for granted. If the injured worker receives a medical bill in the mail, it is best to follow up with the insurance company to make sure it is paid. This can usually be done by a telephone call. Otherwise, I would suggest that the bill be sent by email to the adjuster handling the claim. This creates a record that the injured worker can use for reference if needed at later time. The injured worker may also consider mailing the bills to the insurer with a brief cover letter. Again, it’s always a good idea to keep a copy for reference if needed at a later date.
However, if the worker’s compensation company denies the injured worker’s claim another situation arises. Typically, the worker’s compensation insurance company will issue the denial in letter to the injured worker. This is usually delivered to the injured worker by certified mail return receipt requested.
In South Dakota, we have a statute that requires the injured worker’s health insurance company to pay the medical bills when there has been a denial by the worker’s compensation insurance company (SDCL 62-1-1.3). The health insurance company may require a copy of the denial letter. Also, the health insurance will put the injured worker on notice if the injured worker recovers the benefits at a later date.
If you have a worker’s compensation claim that was denied involving significant medical bills, please call us at ALVINE|WEIDENAAR, LLP.