Should I Treat Through Workers Comp?

You know when you’re hurt.  You experience pain.  You’re physically limited.  Depending on the severity of the injury, you’ve either already been to the hospital or seen a doctor, or you have an appointment scheduled.  What to do when you’ve been injured on the job and how to best handle the situation is one that can be stressful and confusing.  To alleviate such concerns, consultations with our office are free.  You can call and ask any question at any time.  Visit us online at www.dolmanlaw.com.

The question that can arise is whether the injury is one that should be handled through worker’s compensation insurance coverage.  This question can become complicated by the nature of the injury itself.  Other ways in which the answer to the aforementioned question can become less clear is if your employer provides false information through instructing you to treat through your own health insurance.  Another means of uncertainty exists if you’re reluctant to report the injury to your employer out of fear of retaliation.  Such fear can make you unwilling to report a job related injury.  Failure to report a job related injury timely can result in a loss of your eligibility and entitlement for worker’s compensation benefits.[1]

If you attempt to treat through your own health insurance for a work related injury, your health insurance company will deny coverage.  Intentionally or not, treating for a job injury your own health insurance or private health insurance through which you are covered under your family member or spouse’s policy, is prohibited.  Private health insurance through companies like United, Aetna, Anthem, or Humana, do not exist for the purpose of treating work related injuries or conditions.

The denial of coverage from your private health insurance company may not happen immediately.  Meaning, you may be able to attend appointments and have your private health insurance company pay their portion for months or more.  However, sooner rather than later, your private health insurance company will become aware of the fact that the treatment they’re paying for is due to an injury that occurred on the job.  When your health insurance becomes aware of the connection between the condition you’re treating for and it causal relation to your employment, you’re likely to receive a letter from your private health insurance company notifying you of their decision to not only suspend coverage for further treatment, but request reimbursement for ALL the amounts they’ve paid for treatment related to your work injury.

The rule is that a workers compensation insurance company must provide benefits to a worker who has sustained 1.) an injury 2.) by accident, 3.) that arose out of, 4.) and occurred in the course and scope of employment.[2]  The second step is establishing that the injury, its occupational cause, and any resulting manifestations or disability shall be established to a reasonable degree of medical certainty and by objective medical findings.[3]  Establishing an injury through objective medical findings means your injury is revealed through diagnostic tests such as MRI scans.

Establishing that an injury is work related can be made more challenging as a result of the workers compensation insurance company essentially fighting with you to try and prove that you are not entitled to workers compensation benefits. Dolman Law Group can help you navigate this essentially confusing circumstance.  Contact us by calling (727) 853-6275.

Dolman Law Group
5435 Main Street
New Port Richey, FL 34652
(727) 853-6275

https://www.dolmanlaw.com/legal-services/workers-compensation-attorneys/

References:

[1] Fla. Stat. 440.185(1)
[2] Fla. Stat. 440.02(17)
[3] Fla. Stat. 440.09(1)

 

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