Medical Services

Another important benefit provided to injured employees by workers' compensation is payment of related medical bills. Many insurers systematically review proposed services before approving payment.  This is called “Utilization Review”. If the service is approved, treatment usually proceeds without difficulty. However, should the insurer question the reasonableness of the treatment or the relationship of the treatment to the work injury, there is often a dispute. The law does not require the insurance company to pay for all medical services obtained by an employee. Instead, the law requires only the payment of medical bills for treatments considered medically reasonable treatments that are made necessary by the work injury.  When a dispute does arise, it is often necessary to file a claim before the Department of Industrial Accidents to obtain an order from an administrative judge requiring the insurance company to make payment.

 In addition to the payment of your doctor's bills, an employee is entitled to reimburse­ment for the cost of travel to and from approved medical treatment sessions. These "mileage reimbursements” should be made promptly by insurance companies. Insurance companies do not typically inform employees of their right to be reimbursed. You should check with your adjuster to periodically submit an expense reimbursement request.

 

 

 

 

benaLogo