If you have been injured at work and your workers’ comp claim is denied, you are undoubtedly worried about your medical expenses piling up.
There are options to paying your medical bills, even when workers’ comp denies the claim.
If you are concerned about what to do when workers’ comp won’t pay for your treatment, you have come to the right place. This article will explain your options to pay your medical bills.
Ultimately, if workers’ comp denies your claim, you may be responsible for your medical bills, but our goal is to help you avoid that scenario. If you receive a denial, speak with a Charlotte or Winston-Salem workers’ compensation attorney. We can assist you every step of the way.
What Happens to Medical Bills When Workers’ Comp Is Denied?
If you are injured, you must receive the necessary medical care immediately. Delaying or forgoing treatment can cause more harm, significant injury, and possibly long-term or permanent consequences.
Even if you are challenging the denial, you should not discontinue or delay treatment. It is also helpful to have that record of medical care as you continue to pursue your workers’ compensation claim.
Alternative Options for Paying Medical Bills
Here are a few alternative options that you can try if workers’ comp is not paying your medical bills.
Private Health Insurance
If workers’ comp has denied your claim and you have health insurance, you may be able to have your health benefit plan cover your medical costs. Looking at your group health insurance is not always straightforward, though.
Remember, as opposed to workers’ compensation coverage, most health insurance plans have some form of patient responsibility. This might be a deductible, co-pay, or coinsurance percentage, some of which may be relatively high.
Sometimes, health insurance plans deny paying benefits altogether if they suspect the treatment is for a work-related injury or illness, or if they do initially pay, they may seek recoupment of that payment later.
If you do not have private health insurance coverage through your employer or spouse, Medicaid might pay your medical bills. Medicaid is available to low-income individuals with limited financial assets. Should workers’ comp ultimately cover your claim, you must reimburse Medicaid.
Lastly, you might be eligible for Medicare through the federal government if you qualify for social security disability benefits. However, Medicare benefits typically have a lengthy waiting period.
Being unable to work and requiring medical treatment for your injury can be stressful and strain your finances. If your claim is reversed, your attorney will help you seek to recover any out-of-pocket expenses.
Potential Reasons Why a Claim Could Be Denied
There are several reasons why a workers’ comp claim can be denied. Some of the most common causes include the following:
Your injury is not compensable under North Carolina law. The injury must be work-related to qualify for workers’ comp benefits. If you performed duties outside your scope of employment, your claim might be denied.
Failure to Report
You have 30 days in North Carolina to report your injury to your employer. If you fail to do so within the required timeframe, this can result in a denial.
Sometimes, employers will dispute your employment status by claiming you are not an employee or an independent contractor. To avoid paying workers’ comp benefits, employers will misclassify an employee to render them ineligible for benefits.
Regardless of your denial, you should consult a seasoned workers’ comp attorney to discuss your options.
Appealing the Workers’ Comp Denial
Generally, four levels of appeal are available should workers’ comp deny your claim:
- A formal hearing before a Deputy Commissioner of the North Carolina Industrial Commission NCIC,
- An appeal in front of the Full NCIC Commission,
- Appeal to the North Carolina Court of Appeals, and
- Appeal to the North Carolina Supreme Court.
It is not required to have an attorney to appeal the denial, but we highly recommend it.
How Can a Lawyer Help an Injured Worker with Their Workers’ Comp Claim?
A lawyer can help you with your workers’ comp claim in many ways. A seasoned attorney knows the ins and outs of the North Carolina workers’ compensation system and is familiar with the process.
Appeals can be riddled with complex documents, filing deadlines, and strict rules. A successful appeal can provide immense financial and mental relief, and your best chance of success is having a knowledgeable and experienced lawyer.
Speak With an Experienced North Carolina Workers’ Comp Lawyer
Is workers’ comp not paying your medical bills after a work injury? Contact the North Carolina workers’ compensation attorneys at EMP Law today.