Injured employees and those with job-related medical challenges may qualify for workers’ compensation benefits. The available coverage includes both disability benefits and medical coverage, which can be quite valuable.
Even those with decent health insurance may need workers’ compensation coverage for medical care. Workers’ compensation coverage applies to any work-related medical issue, even those that are the fault of an outside party or the employee. Traumatic injuries and work-related medical issues are eligible for medical coverage.
Unlike traditional health insurance, workers’ compensation provides full coverage for care without any coinsurance, co-pays or deductible. No-cost medical care is obviously beneficial for those dealing with work-related injuries.
How long can an employee expect their workers’ compensation medical coverage to pay for their treatment?
Until they fully recover
Most of the time, workers’ compensation benefits continue until the injured employee makes a full recovery. The doctor overseeing their care tracks their progress and determines when they no longer have noteworthy symptoms and can safely return to work.
Until they stop responding to treatment
Some medical conditions do not usually lead to a full recovery. Instead, the worker may always have a few lingering symptoms. Repetitive stress injuries and other conditions may only improve but not fully resolve with care.
If the physician overseeing a worker’s care determines if they have achieved maximum medical improvement (MMI) and may not respond to additional interventions, treatment-related coverage typically ends at that point. Workers may qualify for ongoing coverage for symptom management, such as pain relief.
Until they become non-compliant
Occasionally, workers fail to do what is necessary to improve their condition. They don’t attend physical therapy or follow a doctor’s treatment plan. Workers can theoretically lose the coverage they currently have in cases where there is documentation of their non-compliance with a doctor’s medical recommendation.
In some cases where injuries create lifelong symptoms, workers may qualify for certain types of medical benefits indefinitely. Sometimes, workers may need assistance appealing a decision made by a physician because they disagree with the doctor’s perspective. Other times, they need help with the claims process to maximize the benefits they receive.
Understanding the basic rules that govern workers’ compensation coverage can help employees get the support they require for work-related maladies. Workers’ compensation medical coverage is a crucial benefit for those dealing with painful or functionally-limiting injury symptoms.
