How Does Workers’ Comp Address Medical Treatment for a Work Injury?

 Posted on January 28, 2021 in Workers' Compensation

When employees suffer work-related injuries, they are eligible to receive workers’ compensation benefits. Injuries can occur in workplace accidents, employees may experience repetitive stress injuries due to the activities they perform while working, or they may contract illnesses after being exposed to toxic substances or infectious diseases in the workplace. The costs of medical treatment for work-related injuries will be fully covered by workers’ comp, but employees should be sure to understand their rights and the procedures that should be followed to receive medical benefits.

Understanding Workers’ Compensation Medical Benefits

An employer’s workers’ compensation insurer will be required to pay all costs related to medical treatment that is needed to address the effects of a work-related injury. This includes any immediate or emergency medical care, as well as treatment that will address the ongoing effects of an injury and restore a person to their condition before being injured, or as close to that condition as possible. Covered treatment may include:

• First aid
• Emergency room treatment
• Doctor or hospital visits
• Surgery
• Physical therapy
• Chiropractic treatment
• Medications
• Prosthetics and other medical devices or appliances

Employees should notify their employer as soon as possible after a workplace accident or after a work-related injury begins to affect their activities either while working or outside of work. When receiving treatment, an employee should inform the provider that their injury or illness is work-related, and the provider will bill the employer for the services provided.

An employee is allowed to receive treatment from up to two doctors, as well as any providers that they are referred to by those doctors. While employees are usually allowed to decide which doctors or medical providers they will see, some workers’ compensation insurers use a Preferred Provider Program, which will require an employee to use a doctor within a selected network of providers. In these cases, an employee may see any two providers within the network. If the employee wishes to see a doctor who is outside the network, they can decline to participate in the Preferred Provider Program, but choosing this option will count as one of the two choices of medical providers, and they will only be able to choose one doctor to see. Emergency treatment following an injury and non-emergency care received before reporting an injury do not count as one of a person’s choices of providers.

While employers will be required to cover the costs of an employee’s medical treatment, they may deny a claim if they believe that an injury was not work-related, or they may dispute the necessity of certain types of treatments. An employee may be required to receive an independent medical exam from a doctor of the employer’s choice, or an employer may perform a utilization review to determine whether certain treatments are medically necessary.

Contact Our Aurora Workers’ Comp Lawyers

If you have been injured while working, the lawyers of Kinnally Flaherty Krentz Loran Hodge & Masur, PC can help you file a workers’ compensation claim and ensure that you receive the benefits you deserve. We will answer your questions about medical benefits, and if your claim is denied by your employer, we will work with you to show that your injury was work-related and that all of your medical care should be fully covered. To set up a free consultation with our Kane County workers’ compensation attorneys, contact our office at 630-907-0909.

Sources:

https://www2.illinois.gov/sites/iwcc/Documents/handbook.pdf