What to do When Workers’ Comp Won’t Pay for Doctor-Recommended Treatment

Injured man signs health insurance form

The Virginia Workers’ Compensation Act applies to most employers in the state. If you work for a covered employer and receive injuries on the job, workers’ comp should pay all your medical expenses. Unfortunately, sometimes the workers’ compensation insurance company denies payment for doctor-recommended treatment. This leaves you trying to figure out what to do when workers’ comp won’t pay. What should you do if that happens? The answer to the question depends on two things: the status of your claim and the reason for the denial.

Entitlement to Workers’ Compensation Benefits

If you’re injured during work, you must take certain steps to ensure that you receive workers’ comp benefits. First, you need to notify your employer about the accident within 30 days of occurrence. You should do that as soon as possible after you sustain injuries. Then, to have protection under the state workers’ comp law, you must file a claim with the Virginia Workers’ Compensation Commission.

Your injuries must meet specific requirements to be covered by workers’ comp insurance. Your employer’s insurance company or the Commission may deny coverage if any of the requirements are not met. Our recent blog post, When Does Virginia Workers’ Compensation Law Require Payment For On-the-Job Injuries?, includes a full discussion of the eligibility requirements.

Workers’ Comp Payment of Medical Expenses

For a covered injury, workers receive specific benefits under workers’ comp insurance. One of those benefits is lifetime payment of medical expenses related to the injury. However, there are some limitations on what medical expenses the employer’s insurance company must pay.

It is not unusual for a workers’ comp insurer to deny payment of specific medical expenses. If that happens after you’re injured, you need to pursue your rights. In many cases, the best way to fight a denial is to consult with a Virginia workers’ compensation lawyer.

Reason for Denial of Medical Expenses or Treatment

An insurance company may deny payment for medical expenses for any of several reasons. The reason in your case determines the appropriate way to proceed.

In some situations, workers’ comp provides coverage immediately after an accident occurs and is reported to the employer. If the insurance company initially paid your medical expenses and then denied payment of a specific bill, there is a reason. It could be due to the fact that your employer has not officially accepted your claim or because you haven’t filed a claim with the Workers’ Compensation Commission. It also could be that the company determined that your injury doesn’t qualify for coverage or because you did not get treatment from a physician on the recommended list provided to you. There may be other reasons as well.

If you face this situation and have not filed a Claim for Benefits with the Workers’ Compensation Commission, you need to do so immediately. Since the insurance company denied payment, you should talk with an experienced workers’ comp lawyer before you file the claim. The contents of your Claim for Benefits may affect your entitlement to benefits.

Consulting with a knowledgeable Virginia workers’ comp attorney is advisable in several different situations — and denial of payment is one of them. If you already filed a Claim for Benefits with assistance from legal counsel and payment of medical expenses is denied, you should contact the same attorney about the denial. If you didn’t have help from a lawyer when you filed the claim, you should contact an experienced workers’ comp attorney as soon as possible.

Time limitations apply to protecting your rights in a workers’ compensation case, including notifying your employer about the injury and appealing denial of a claim. It’s important that you act quickly after an injury, if the insurance company refuses to pay benefits, or if the Commission denies your claim. Failure to act in a timely manner could result in losing your right to coverage and compensation.

Getting Medical Treatment when Payment is Denied

Getting proper medical treatment after a work injury is extremely important. If the insurance company denies payment for the treatment your doctor recommends, you may have a couple options for going ahead with the treatment. If you have health insurance, you can ask your health insurance company to pay for the treatment. If you eventually get workers’ comp coverage for the treatment, the health insurance company will be reimbursed.  If you do not have health insurance a knowledgeable workers’ compensation attorney should be able to direct you to a medical provider who can provide you treatment without you incurring an immediate cost.

If payment was denied because the doctor was not on the authorized list you received, you can visit a doctor on the list. If that physician recommends the same treatment, the workers’ comp insurance company may pay for the treatment.

When issues arise in a workers’ compensation claim, a skillful Virginia workers’ comp attorney can help you address the issues. The workers’ compensation process is extremely complex, especially if the insurance company denies coverage or benefits. Your lawyer helps you navigate through the entire process, while you focus on your recovery. If negotiating a settlement of your claim becomes necessary, your lawyer makes certain that the settlement protects all your rights, including coverage of medical expenses initially and in the future.

Schedule a Free Consultation with Our Respected Richmond, Virginia Workers’ Compensation Attorneys

Pursuing a workers’ comp claim can be extremely frustrating and confusing for an injured worker, especially because the Virginia law and rules are extremely complicated. At the Richmond law firm of Renfro & Renfro, our dedicated workers’ compensation lawyers advocate vigorously for every client.

If you suffer an on-the-job injury, you should receive the compensation that you deserve under the law, including payment of your medical expenses. Don’t be left wondering what to do when workers’ comp won’t pay. Instead, let an experienced lawyer make certain your claim is handled properly. Our Virginia workers’ compensation lawyers take the stress and worry out of pursuing a claim following denial of a claim or refusal to pay medical expenses. We welcome you to contact us for a free consultation.


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