Does Workers’ Comp Cover Medical Bills in Bloomington?

If you’ve experienced a work-related injury, contact Strong Law Offices at (309) 393-2928 for help with your workers' comp claim.

An Overview of Workers’ Comp

Workers' compensation is insurance that protects employees injured on the job, covering work-related injuries without needing personal injury claims against employers. In Illinois, these laws apply to nearly all employees, including part-time and full-time workers, from their first day of employment. This coverage includes injuries from specific incidents and cumulative injuries, like repetitive stress. The amount of workers' compensation benefits depends on your injuries.

If you’re injured at work, workers' compensation can reimburse medical expenses, a part of lost income, and future costs like long-term care and rehabilitation. According to the Illinois Workers’ Compensation Commission's 2023 report, about 200,000 work-related accidents occur annually, resulting in around 40,000 claims. This indicates that many claims are settled without commission involvement, but it also reflects that employees often do not claim their entitled benefits.

What Medical Expenses Are Covered by Workers’ Comp in Bloomington?

Workers' compensation must cover all medical expenses for employees who sustain injuries while performing their job duties. This encompasses all necessary care to diagnose, alleviate, or cure the injury. Workers' comp also provides ongoing mental, physical, or vocational rehabilitation coverage.

To qualify for medical bill coverage under workers’ comp in Bloomington, the medical treatments must be deemed necessary and reasonable for addressing the effects of the workplace injury. Generally, medical expenses are eligible for compensation if the procedures seek to diagnose, treat, or relieve symptoms associated with the injury, and if they align with accepted standards of care. Covered medical costs directly linked to a work-related injury or illness may include:

• Emergency room visits or hospital stays
• Surgical procedures
• Prescription medications
• Physical or occupational therapy
• Mental health counseling
• Continuous treatment, such as chemotherapy or radiation

Ambulance Costs

If you experienced a serious injury that required an ambulance ride to the hospital, you can be reimbursed for the ambulance expenses. Since the ambulance service may not have information about your employer’s workers’ compensation insurance, they might send the bill directly to you. In such cases, it's important to notify your employer.

Emergency Room Visit

Emergency room visits can be costly, but you can receive compensation in Illinois. You can choose two doctors for work-related injuries unless your employer has a Preferred Provider Program (PPP); in that case, both must be in-network doctors. If you opt out of the PPP, you can only select one doctor, which counts as one of your choices. However, emergency care does not impact your choice of doctors and is covered in addition to the treatment from your selected doctors.

Treatment

In Illinois, workers’ compensation covers medical expenses for treatment related to work injuries, including diagnostic tests, surgeries, and medications deemed "reasonable." For example, costs for setting a fractured arm in a cast are covered, while alternative treatments, like acupuncture, are less likely to be reimbursed as they are not standard. Treatment must directly relate to the injury. For instance, high blood pressure management expenses won't be covered if you suffered a broken leg.

Ongoing Care

Workers’ compensation in Illinois also includes coverage for ongoing medical treatment. If you've suffered a serious injury that necessitates continuous care, like physical therapy, you can be reimbursed for the expenses related to that therapy. Additionally, for chronic conditions, such as cancer, that require ongoing treatment, workers’ compensation is expected to cover those costs as well.

How to File a Workers’ Comp Claim for Medical Bills

While the procedure may vary from state to state, filing a workers’ comp claim for medical expenses in Illinois generally follows these steps:

Report Your Injury to Your Employer

You should notify your employer about work-related injuries as soon as possible. In Illinois, you have a maximum of 45 days from the date of the injury to report it, or you risk losing your eligibility for workers' compensation. Informing your employer promptly is essential for starting the necessary paperwork to file a work injury claim, which typically works in your favor.

The insurance company might deny your claim if you wait more than 45 days to report your injury. They could argue that the injury happened after the incident, or that your condition deteriorated because of the delay in reporting.

Seek Medical Attention and Document Your Injuries

After notifying your employer about your injury, they should arrange a medical evaluation. A qualified physician will assess your injury and determine your ability to return to work and when you reach maximum medical improvement (MMI), where no further recovery is expected.

You should seek medical attention after an injury, even if it seems minor. A doctor can evaluate your condition and advise on your work return timeline, which is crucial for compensation claims.

To maximize compensation, gather as much evidence as possible. Prompt medical attention establishes a connection between your injury and work, and documenting treatment is vital for showing the impact on your life and totaling medical costs, which are important for your workers' compensation claim.

File a Claim for Workers' Compensation

Working closely with your workers’ comp attorney in Bloomington is important to ensure your application is filled out correctly. Once you have completed the application, you should provide a copy to your employer and submit the original to the appropriate state agency. In Illinois, it is necessary to deliver signed copies of the application to the Illinois Workers’ Compensation Commission. You have a maximum of three years to file your workers' compensation claim from the date of your injury.

Since this application serves as your official claim for benefits, submitting accurate, complete, and error-free information is vital. Make sure to fill out all required forms thoroughly and correctly. Present all relevant details, facts, and reports regarding your injury, and avoid omitting important information.

Neglecting to provide requested documents, submitting incomplete medical records, or making inconsistent statements about your injury may lead to a denial of your claim. While the accuracy of your paperwork and meeting deadlines does not ensure the success of your claim, it certainly helps reduce the likelihood of delays or denials.

An attorney can play a key role in helping you ensure that your documentation is complete and precise when filing a claim, helping to prevent future complications.

Wait for Approval or Denial of Your Claim

If your claim is rejected, you have the option to appeal. If your claim is accepted, you will receive a compensation offer, either a one-time payment or distributed in installments over time.

Negotiate Settlement

If you find a workers' compensation offer insufficient, you can negotiate for a higher amount and are not obligated to accept it. Hiring a workers' compensation attorney can help you achieve a fair settlement. If an agreement isn't reached, you may take your case to trial. In Illinois, it generally takes about 14 days to receive your settlement check after your claim is finalized.

When to Consult a Workers’ Comp Lawyer About Denied Medical Coverage

You should consult a workers' compensation lawyer who knows what types of injuries or illnesses are covered by workers' compensation if your claim for medical coverage is denied. You should do so particularly if you suspect the denial is unjust, you're having difficulties obtaining essential medical treatment, or your employer or insurance company is uncooperative regarding your claim. You should know what to consider when hiring a workers' compensation lawyer to ensure that you have an attorney you are comfortable with. Several circumstances warrant consulting a workers’ comp attorney for a denied claim, including:

Denied Necessary Medical Treatment

If your doctor suggests treatment for your work-related injury, but the insurance company denies coverage, you may consider filing an appeal if your initial claim is rejected. It's advisable to seek assistance from an attorney, as they can provide valuable insight into your entitlement to compensation.

Disagreement Over Severity of Your Injury

When the insurance provider challenges the severity of your injury and refuses to cover necessary treatment, you may need a workers' comp lawyer.

Pre-Existing Condition Complications

If your injury is linked to a pre-existing condition and the insurance company attempts to deny coverage, workers’ compensation should still cover you if your job exacerbated your condition. Seeking assistance from an attorney can be beneficial in pursuing such a claim.

If your claim is denied, you can appeal the commission's decision. Hiring a workers' compensation attorney can increase your chances of getting your claim approved more quickly and lead to a larger settlement. Moreover, having a lawyer by your side ensures you’re prepared for representation if your case is turned down. Contact us at Strong Law Bloomington for an attorney ready to help you.