What Happens to Medical Bills if Workers’ Compensation Is Denied?

If your workers’ compensation claim is denied, you may have to pay your medical bills out of pocket, at least temporarily. This can include expenses for doctor visits, hospital stays, medication, physical therapy, and other treatments related to your injury.

A denied claim doesn’t mean you’re out of options. Acting quickly and seeking help can make a big difference in how your medical bills are handled. After reviewing the details of your case, an Atlanta workers’ compensation lawyer will review your options.

How a Denied Workers’ Compensation Claim Impacts Medical Bills

When your workers’ compensation claim is denied, the insurance company is no longer responsible for paying your medical bills. This means you may need to cover the cost of your treatment for the time being.

If your claim is denied, you may have to use your personal health insurance, pay out-of-pocket, or make arrangements directly with your healthcare providers. Unless and until your denial is overturned on appeal, workers’ compensation will not cover your expenses. Types of medical bills affected include:

• Emergency care: If you need an ambulance, ER visit, or urgent care right after your injury, those bills can be high. Without an approved workers’ comp claim, these charges may fall on you or your health insurance.
• Follow-up visits: Appointments with doctors, specialists, or physical therapists after your initial treatment also become your responsibility. This includes routine checkups, diagnostic tests, and evaluations.
• Medication and rehabilitation: Prescription drugs, pain management, and physical therapy are often necessary for recovery. These costs can add up quickly and are not covered if the claim is denied.

Even though a denial is stressful, you still have options. You may be able to appeal the decision or find temporary ways to manage the costs while your case moves forward.

Options for Managing Medical Bills After a Workers’ Compensation Denial

Managing medical bills after a denial can be difficult, but you still have options. Acting quickly, staying organized, and seeking help can make a big difference. Here are the most common ways to handle your expenses during this time:

Use Personal Health Insurance

If you have private health insurance, you may be able to use it to cover your medical costs after your workers’ comp claim is denied.

Your health insurance might not cover everything. Some plans exclude work-related injuries, and others may require higher out-of-pocket costs like copays and deductibles. Check your policy or call your insurer to understand your benefits.

If you win your workers’ compensation appeal later, your health insurance provider may seek reimbursement for what they paid. This process is called subrogation. It means the insurer may collect some of the settlement or benefits you receive from the workers’ compensation insurer.

Negotiate With Healthcare Providers

Many hospitals, doctors, and clinics are willing to work with patients who are dealing with claim denials. Ask if you can make monthly payments instead of paying the full amount at once. This can cause your bills to become more manageable over time.

Let your providers know you are appealing a workers’ compensation denial. Some may agree to delay billing or hold off on sending your account to collections while your case is pending.

Pay Out of Pocket

If you don’t have health insurance or can’t get help from your providers, you may have to pay some or all of the costs yourself. Save every receipt, invoice, and explanation of benefits (EOB). These documents will be important if you later win your appeal or seek reimbursement from a third party.

Paying out of pocket can be financially overwhelming. Unpaid bills may go to collections, affect your credit score, and cause long-term financial stress. Be proactive and communicate with your providers to avoid these outcomes.

Appealing a Denied Workers’ Compensation Claim

If your workers’ compensation claim is denied, you have the right to appeal the decision. The appeals process gives you a chance to provide more evidence and explain why your injury should be covered.

Each state has its own system, but most appeals follow these basic steps:

• File an appeal: You must submit a written appeal by a specific deadline, often within 30 to 90 days after receiving the denial letter.
• Hearing or review: Your case will be reviewed by a workers’ compensation board, administrative judge, or similar authority. This may involve a hearing where you and your employer present evidence.
• Decision: After reviewing your case, the board or judge will decide whether to uphold or reverse the denial.

Potential Outcomes

Once you file an appeal, the decision can go in a few different directions. The outcome will depend on the evidence you provide, the strength of your case, and the laws in your state. An experienced workers’ compensation attorney will help you prepare for what comes next and plan your next steps.

The potential outcomes of a denied workers’ compensation appeal are as follows:

• Reversal of denial: If your appeal is successful, the denial will be overturned. You may receive payment for past medical bills, lost wages, and future treatment.
• Partial coverage: Sometimes, the board agrees to cover only part of your claim. For example, medical treatment is approved, but not wage replacement.
• Continued denial: If the appeal is denied, you may have options to request another review or take your case to a higher court, depending on state law.

Appealing a denied claim takes time and effort, but it can lead to the benefits you deserve. Don’t ignore a denial; know your rights, act quickly, and get help if needed.

Talk to a Workers’ Compensation Lawyer About Your Medical Bills

If your workers’ compensation claim has been denied, you don’t have to deal with the stress of medical bills on your own. A workers’ compensation attorney will explore your options and fight to get your medical treatment covered. To get the support you need, contact The Strong Arm™ today. We offer trusted legal guidance and strong representation.

At John Foy & Associates, we help injured workers across Georgia succeed in the claims and appeals process. With more than 350 years of combined legal experience, our team knows how to build a winning case.