Medical treatment can begin before you fully understand how the workers’ compensation system works. That can leave injured employees wondering whether they will have to pay doctor visits, prescriptions, physical therapy, or other treatment costs themselves.
In California, medical care that is reasonably required to treat a covered work injury is generally paid through the workers’ compensation system. Our work comp legal help in Orange County can review unpaid medical expenses, explain what the claims administrator should cover, and help address problems affecting your workers’ compensation benefits.
Who pays my medical bills after a work injury?
Your employer is responsible for workers’ compensation medical benefits for a covered work injury or illness. In practice, the bills are generally handled by the employer’s workers’ compensation insurance carrier or claims administrator. A self-insured employer may handle those obligations through its own claims system.
Workers’ compensation medical benefits can cover treatment that is reasonably necessary to cure or relieve the effects of the job-related injury. Depending on the injury and approved treatment plan, that may include:
- Doctor and specialist visits
- Hospital care
- Prescription medication
- Diagnostic testing
- Physical or occupational therapy
- Surgery and follow-up care
- Other medically necessary treatment
You generally should not have to pay deductibles or copays for authorized workers’ compensation medical treatment.
Who pays for treatment while my claim is still being investigated?
You don’t necessarily have to wait until the claims administrator formally accepts your claim before receiving medical care. Within one working day after you file a DWC-1 claim form with your employer, appropriate medical treatment must generally be authorized while the claim is being investigated. Up to $10,000 in treatment may be provided before the claim is accepted or denied.
This protection can be important when an injury requires treatment immediately, but the claims administrator has not yet decided whether to accept or deny the claim. The treatment still must comply with California workers’ compensation medical-treatment rules. A pending claim does not mean every requested service is automatically approved.
Can a doctor or hospital send me the bill?
You generally should not receive a medical bill for treatment of a work injury if you filed a workers’ compensation claim and the medical provider knows the injury is work-related. California DWC states that it’s illegal for a physician or medical facility to bill an injured worker when the provider knows the injury is, or may be, work-related.
That does not mean billing mistakes never happen. A provider may have incomplete insurance information, may not realize the treatment relates to a workplace injury, or may send the bill to the wrong party.
If you receive a bill for treatment related to your work injury, do not assume you are personally responsible for paying it. Check whether the provider has your workers’ compensation claim information and whether the treatment was connected to the accepted or pending work injury.
What should I do if I receive a medical bill?
Keep the bill and any related correspondence rather than ignoring it. It is also worth notifying the claims administrator if a provider continues sending bills directly to you.
You may need to provide the medical office with information such as:
- Your employer’s name
- The workers’ compensation insurance carrier or claims administrator
- Your claim number, if one has been assigned
- The date of injury
- Confirmation that the treatment relates to the work injury
Who provides work comp legal help in Orange County, CA for unpaid medical bills?
Unexpected treatment bills can add financial pressure at the worst possible time. Our team helps injured workers in Aliso Viejo and throughout Orange County determine whether medical expenses should be handled through workers’ compensation and address problems when providers or claims administrators leave eligible costs unpaid.
Understanding the rest of the claim can be just as important. You may also want to know which medical travel expenses may be reimbursed and how long an Orange County work comp claim can take. Contact our office for a free consultation to discuss your medical bills, treatment issues, and the next steps in your claim. Contact our office today!
