For workers injured on the job, coverage of medical expenses is one of the important benefits provided under the Virginia Workers’ Compensation Act. Injured workers should understand what the medical coverage includes. If the insurance company denies payment of medical expenses that should be covered, the worker may be able to dispute the denial with assistance from a workers’ compensation lawyer.
Medical Coverage in the Workers’ Compensation Act
A specific section of the act, found at Virginia Code § 65.2-603, provides that:
As long as necessary after an accident, the employer shall furnish or cause to be furnished, free of charge to the injured employee, a physician chosen by the injured employee from a panel of at least three physicians selected by the employer and such other necessary medical attention.
The statutory section includes other provisions relating to medical services that the employer is required to provide. Based on the law, an injured employee is entitled to coverage for medical services resulting from the work injury for the rest of the worker’s life, as long as the worker obtains services from authorized medical professionals.
Covered services include initial visits to medical professionals, as well as long-term treatment and services. The law specifies some other medical services, including:
- Prosthetic and orthotic appliances
- Mobility devices, such as wheelchairs, scooters, walkers, canes, and crutches, as well as fitting, maintenance, and training in the use of the devices
- Modifications or equipment for the worker’s vehicle, in some circumstances
- Bedside lifts, adjustable beds, and home modifications like ramps and handrails
Vocational rehabilitation services are also part of the services covered under the Act.
Examples of Reasonable and Necessary Treatment
In some cases, coverage of specific services may not be clear from the statutory provisions. The Workers’ Compensation Commission and numerous Virginia court decisions provide that coverage generally includes reasonable and necessary treatment resulting from the injury. There are no co-pays, no deductible amounts. Coverage lasts for the duration of the worker’s life.
To receive coverage, the worker needs to stay in the referral chain established by the insurance company, with the possible exception of the initial emergency treatment. That means going to an authorized physician from the panel provided by the employer. If that doctor refers you to other medical professionals (like a surgeon), workers’ compensation also pays for those services. While there are some limitations on medical expense benefits, workers’ comp also covers a wide range of other medical services related to an on-the-job injury.
Hospitalization is fully covered, whether for emergency treatment of the injury initially or for surgery to correct issues resulting from the injury. Diagnostic tests are covered as well. The tests may include x-rays, MRIs, hearing or eye tests, and other types of analytic tests to determine the nature of injuries and the appropriate treatment.
Prosthetic and orthotic devices may include a wide range of devices. Coverage includes fitting the device, as well as training in how to use the device. Examples of covered items include artificial limbs, dentures, wheelchairs, and scooters, as well as special footwear or shoes necessitated by the injury.
Employers also may be required to pay for palliative treatment that provides temporary relief that relieves symptoms, reduces stress, and improves the worker’s quality of life. In some cases, assistance from mental health professionals is a necessary part of the treatment as well. Many other types of therapy are also included in workers’ compensation medical services, such as physical therapy, occupational therapy, and speech therapy.
Medical benefits also include reimbursement for travel to and from an authorized doctor. Many injured workers are unaware of the availability of travel reimbursement. In addition, services by a home health care provider or a family member may also be covered by workers’ compensation in some circumstances.
Denial of Medical Expense Payment
Even though the law requires payment of medical expenses related to a work injury, an insurance company may dispute payment for treatment recommended by a treating physician by denying payment or delaying approval. Denials and delays can seriously jeopardize the injured worker’s recovery from the injury.
Sometimes, a denial may occur simply because the insurance company needs additional information from the doctor’s office. In that case, it may be possible to resolve the issue by providing the information. But in other situations, the insurance company may want the worker to change doctors or may simply deny or not respond to the request to avoid paying for the service.
If an insurance company unjustifiably denies or delays necessary medical treatment, the injured worker can seek review by the Workers’ Compensation Commission. However, cases involving denial of medical treatment are complex and challenging to pursue. Getting assistance from an experienced workers’ compensation attorney is strongly recommended if you have a job-related injury and are experiencing issues with getting your medical expenses paid by the workers’ compensation insurance company.
Talk With a Richmond, Virginia Workers’ Compensation Attorney
If you suffer an on-the-job injury, you should receive the full benefits that you deserve under the law, including payment of your medical treatment expenses. Sometimes, you need assistance from a knowledgeable workers’ compensation lawyer to get the treatment you need. Our Virginia workers’ compensation lawyers at Renfro & Renfro are here to help. We welcome you call us at (804) 601-4433 or to contact us online for a free consultation.