What Happens if I Use My Personal Insurance for Workers' Comp "Denied" or Delayed Treatment?

 

Recently one our clients expressed some anxiety because he had been putting workers' comp-related injury charges through his personal insurance. He feared that his personal insurance company would discover that these charges were workers' comp-related and penalize him. 

He raised a very good question: If I have a workers' comp injury, can I treat through my personal insurance?

The answer is pretty simple, though I'm sure it didn't seem to him at the time. Yes,  you can use your personal insurance for treatment that is being DENIED by workers' comp. Even if the treatment is ultimately approved, but you needed the treatment before it was approved in order for your medical care to continue, you may use your personal insurance. After all, you are paying them to provide coverage for your health. 

If your workers comp claim has been accepted, it is always better to have your doctors and hospitals bill the workers comp insurance company directly, for several reasons:

  • there is no co-pay or out of pocket expense for workers comp medical treatment

 

  • the doctor or hospital cannot bill you for the balance after accepting the workers comp insurance payment (some doctors offices and medical practices don't understand or seem to know this - when this happens to one of our clients, let's just say the billing office learns real quick that this is illegal)

 

  • when the workers' comp insurance is billed for your work injury treatment, they are aware of all of the injuries and the extent of your injuries - you don't want any surprises, or for the insurance company to think you've recovered because they haven't received a bill in 6 months.

With a serious work injury, and need for immediate medical treatment or hospitalization, you probably don't even know the name of the workers comp insurance, the claim number, address, etc.  and that's ok. 

In that situation, give the hospital your health insurance information and get the medical treatment you need.  Your health insurance company can try to get repaid by the workers comp insurance company once you have that information.  After all, your treatment and health are absolutely the number one priority so you don't want any delays in medical care. 

Workers' comp in DC, Maryland and Virginia is a complicated system, and with a serious injury, can be overwhelming, stressful and ultimately costly to you and your family if you don't handle it right.

If you were seriously injured at work, call us at (202) 393 - 3320 or fill our a contact form on our site and we'll get you the best information available to help you and your family through the workers comp process. 

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