By law, workers’ compensation insurance in New York State will provide payments that (i) replace a portion of an employee’s lost wages when they are unable to work due to employment-related injuries; (ii) reimburse certain medical expenses incurred by the employee for treatment of those injuries; and (iii) provide death benefits if the employee dies as a result of his or her injuries.

Notwithstanding this coverage, an injured employee should not assume that these benefits will pay for all medical bills. Many workers’ compensation insurance companies will deny payments, for example, for services that are not deemed to be medically necessary.

 If you have been denied reimbursement for your medical bills after a work-related accident, call Friedman, Levy, Goldfarb, Green & Bagley, P.C. in Manhattan to consult with a personal injury lawyer about pursuing your claim and pressing an appeal from any denials of benefits to cover your medical bills.

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Medical Bills That Are Commonly Covered by Workers’ Compensation

In most cases, an employee that suffers on-the-job injuries will receive reimbursement under workers’ compensation for:

  • emergency room services;
  • diagnostic tests, including X-rays, MRI’s, blood tests, and other standard medical procedures;
  • rehabilitation and physical therapy;
  • transportation costs for doctor’s visits;
  • certain types of medical equipment.

Medical bill payments will be subject to limits, particularly for physical therapy and other medical services that are provided over several weeks. A knowledgeable and experienced workers compensation lawyer will challenge these limits and pursue compensation for a longer stretch of therapeutic services.    

Medical Bills That Are Commonly Denied

Workers’ compensation benefits default to standard medical treatments over alternative therapies, such as acupuncture or experimental drugs. An injured employee should consult with their physician and should verify coverage with the workers’ compensation insurance carrier before pursuing any alternative therapies. This is to avoid surprise denials of coverage when medical bills are submitted for reimbursement.

Qualifying for Medical Bill Payments

The most direct way to start the benefits is to notify your employer’s insurance carrier that you intend to ask for them. You also intend to inform the first treating physician that you see that you were injured in a workplace accident. The insurance carrier will likely require you to procure pre-approval before you schedule an appointment with a physician. They may also refer you to a health care center within their provider network.

You might find yourself in a conflict between a workers’ compensation insurer that is not approving medical treatments, and your health insurance that is denying coverage because your injuries or illness are work-related. An experienced attorney is your best resource to resolve this conflict in your favor.

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The Benefits of Retaining a Workers’ Compensation Lawyer

A workers’ compensation lawyer will do more for an injured employee than just resolve conflicts between insurance carriers.  For example, an attorney will:

  • negotiate cash settlements for injuries incurred in the workplace in an amount that is greater than any voluntary settlement offers that an insurance carrier might offer;
  • verify that an injured worker is receiving the full amount of benefits for lost wages, including any overtime wages that the worker would expect to receive;
  • push to get coverage for all of the medical treatments that an employee needs to recuperate fully from injuries, and to argue for treatment by an employee’s regular medical team over an insurance carrier’s designated physicians;
  • verify that all claims are filed within statutory deadlines, and extend those deadlines when necessary to increase benefits that may be payable to an injured worker;
  • fight back against insurance company claims that an employee’s injuries are not severe or are only an exacerbation of an existing condition.

Contact Us for Legal Representation in Workers’ Compensation Claims 

When you suffer a workplace injury in Manhattan, the Bronx, Long Island, Brooklyn, or elsewhere in the general NYC metropolitan region, please contact us. You can speak directly with one of our experienced construction accident lawyers to improve your chances of reimbursement for your medical bills. We can also help recover the largest available workers’ compensation payments to replace your lost wages and other expenses.

Additional Resources:

  1. Workers Compensation Benefits.
  2. Workers’ Compensation NY.
  3. Workers’ Compensation Coverage – Understanding Workers’ Compensation Insurance.