- The employee decides not to make a workers’ compensation claim with their employer but instead tries to treat injuries using their health insurance.
- Instead of filing a worker comp claim, employers do not inform the insurance company but instead offer to pay for medical expenses for the employee through their own pockets (or the company’s money).
- The injured employee chooses to pay for medical expenses themselves.
If you are considering any of the options above, take note of the following tips. The consequences of selecting any of these choices could be devastating and irreparable.
The Difference Between Private Health Insurance and Workers’ Compensation
Workers’ compensation is a way to pay for lost wagesmedical expenses and lost wages in connection with the treatment of illnesses or injuries which are caused by or through your job. This system is in place because your private health insurance is not required to cover injuries you suffer during your job. It is not only the case that a private insurance company is not required to cover the injuries you sustain following an injury to the personal; however, they can not pay for any treatment they believe is related to a workplace accident.
When individuals decide to receive treatment by way of their private health insurance for injuries that they sustained during work and in the course of their work, they often have their insurance provider investigate into the accident. Notably, they will examine whether the injury occurred by or was connected to the individual’s work. Insurance companies handle thousands of claims daily and know how to explore these cases and if an injury is suspicious to be linked to work.
This type of investigation could occur when your health healthcare providers (doctors or hospitals, chiropractors, etc.) submit your medical bills to your health insurance provider. Sometimes, the investigation may not start for a couple of days after the private health providers send you invoices. But, again, the time will depend on the healthcare insurance provider involved and the injuries you suffered.
The fact that an insurer will not reject the claim immediately or even pay the first two medical bills isn’t a guarantee that they’ve been deceived or that they are not going to continue to cover the cost. In any case, all private health insurance providers look over the treatment and bill notices that healthcare providers make. The review involves examining medical records for the type of incident that appears to be connected to a workplace accident. Insurance companies often know what injuries incurred by work look like.
What If Your Doctor Finds Out You Were Injured at Work?
If someone blatantly tells their doctor that an injury was at work, the doctor won’t treat it. There’s a reason for this: they are aware it is likely that the insurance provider will eventually likely to reject the claim and, consequently, they’ll not get paid. Be aware that it’s more an issue of what happens if you’re private and your health insurance provider finds out, not whether they do.
Once the information is discovered, the private health insurance provider will cease any payments currently in place and grant authorization for future payments. In addition, they will likely request reimbursement for any amount paid to you in connection with your treatment. They’ll seek payment directly from you.
Denial of Lost Wage Benefits
Alongside the above dangers, you won’t be compensated for the time that you’re off work to treat your injuries if you decide to receive treatment with your health insurance provider. However, suppose you are using workers’ compensation health insurance to cover your medical treatment and are put on a no-work or restricted status for work. In that case, you may receive your compensation in place of lost wages.
This money is vital to reduce the economic losses that could result from being unable to work. There is no such protection for private insurance policies. If you begin receiving money from a short- or long-term disability plan because of an injury you didn’t report to workers’ compensation, that income could be cut off. However, this isn’t always the case, as it is contingent on the language used in the disability policy; however, it’s a possibility.
Paying Co-Pays Depends on Your Insurance
If the above reasons do not suffice, consider that health insurance for private individuals has a co-payment. Of course, the amount you pay for your co-pay is contingent on the coverage you have. The amount may be significant if you suffer from substantial accidents at work. This is especially true if you visit numerous doctors times and repeatedly (requiring that you pay a lot of co-pays). Also, if surgery is needed, it will require an additional cost compared to a typical doctor’s visit.
If the claim results from workers’ compensation coverage and the claim are through workers’ comp, there’s almost always no co-payment requirement. However, suppose you get to a certain point called “m” Aximal medical enhancement that is, the worker’s compensation company could require a $10.00 co-pay for medical appointments. However, this is typically not the case. It is possible to look up the Legal Dictionary to find the more specific definition of Maximum Medical Improvement.
To receive treatment from the worker’s compensation company to treat injuries you suffered while working, You must follow specific rules and regulations. One of those requirements is reporting the incident promptly. This, as well as more information about Florida workers insurance laws are available on the official Internet Site for Florida Legislature. Inability to report an accident or illness promptly could result in being barred forever from receiving benefits for worker’s compensation in the event of an injury.
You might have heard that getting treatment from the worker’s compensation insurance company is challenging or difficult or. It cannot be easy. It is common to find a worker’s compensation insurance company to try to mislead injured workers regarding the type of benefits they’re entitled to. This is among the primary reasons why workers injured in the course of work are advised to consult an attorney for personal injury regarding the work-related injury.
They have experts in legal matters and lawyers on their team throughout the day. They also handle hundreds of cases every year, and they know the ins and outs. There’s no risk of consulting with an attorney and no charges until they have won your case. So you have nothing to lose and nothing to gain from having a conversation with an attorney.
Why a Workers Compensation Attorney is Essential After an Injury
Becoming accustomed to the many different curveballs that insurance and an injury could toss at you when you recover from a workplace accident is a challenging task. The damage caused by work injuries can be significant; therefore, it’s in your best interests to avoid trying to deal with everything by yourself but instead consults a professional dedicated to the best outcome for your situation. A skilled attorney for personal injuries who is specialized in workers’ compensation cases can make the difference between poor insurance coverage and total compensation for the harm you’ve been afflicted.