If you’ve suffered a workplace injury or illness that requires expensive or long-term medical treatment, you’re probably thinking about the financial realities of your situation.
Worker’s compensation is designed to ensure that you get the benefits you need to pay your medical bills and get the quality treatment you deserve. But what happens to your medical bills if your worker’s comp claim gets denied?
If you’ve been denied the benefits you’re entitled to, you’re not alone. Keep reading to learn what to do in the event of a denied claim and how it can affect your hospital bills.
What To Do if Your Workers’ Comp Is Denied
If you’re injured at work, you’re entitled to workers’ compensation to help cover the cost of this hardship. Workers’ comp benefits frequently include compensation for lost wages, vocational rehabilitation, and medical expenses.
Once you’ve filed a workers’ comp claim following a workplace injury or illness, the insurer has 60 days to accept or deny your claim. This can leave you without the compensation you need to pay outstanding medical bills and cover other basic necessities. But receiving a letter of denial isn’t the end. You can still fight to get the benefits you deserve through an appeal.
Here’s what you should do if your workers’ comp claim is denied:
Contact a lawyer
If your claim has been denied, you don’t have to give up. Filing a claim and arguing your case while suffering from your injury can be frustrating and taxing, but you don’t have to do it alone. Reaching out to an attorney with years of experience with Oregon workers’ comp laws and regulations can significantly increase your chance of winning your case.
Refile your worker’s comp claim
If your claim was denied due to an error, refiling the claim is likely the best course of action. Your attorney can help you correct the information and ensure that you have the best chance possible of being approved upon refining.
Request a hearing
If you believe that the insurance company responsible for assessing your claim has unfairly denied your benefits, you have the right to appeal by filing a Request for Hearing form with the Workers’ Compensation Board.
Keep in mind that you must file your request within 60 days of the denial in order to be considered. Your attorney will attend your hearing with you to represent your case and provide additional evidence.
Submit a new claim
In some cases, a complete reworking of your claim may be necessary. If your paperwork contains inaccurate or insufficient details, or you received a poorly conducted IME (independent medical examination), submitting a new claim may be the best way to increase your chances.
Why Do Workers’ Compensation Claims Get Denied?
Every year, thousands of people receive unfair claim denials. In fact, almost 15% of initial injury claims and about 33% of repetitive-use injury claims are denied. There are a variety of reasons why insurers deny workers’ comp claims, but the most common reasons include:
- Filing mistakes: Without the help of an experienced lawyer, it’s common for workers to accidentally leave out details or not advocate for themselves during the claims process.
- IME Reports: A hand-picked IME doctor may say your injury is actually the result of a pre-existing condition or raise doubt about the authenticity of your injury.
If your workers’ compensation claim is denied, you don’t have to give up the fight. You can appeal the denial to the Oregon Workers’ Compensation Board. At RGMR, we’ve helped countless injured workers in Oregon appeal unfairly denied claims and get the compensation they’re entitled to.
What To Do While Waiting for Your Claim to Get Reapproved
If your claim was originally denied and you just submitted a new claim to get reapproved, you can and should continue to treat your injury. Not only does seeking and receiving treatment improve your chances of making a full recovery, but it also indicates to the Oregon Workers’ Compensation Board that you are sincerely injured and require treatment.
You’re not alone. At RGMR, we can help you find honest, high-quality medical providers to treat your injury. We’ll also help you talk to your doctors about paying for your medical bills while you wait for your workers’ comp claim to be accepted.
What Medical Bills Does Workers’ Comp Cover If Your Claim is Approved?
In Oregon, workers’ compensation insurance pays for injured workers’ medical treatment and lost wages on accepted claims, assuming the worker’s injury or illness is work-related.
In general, an accepted workers’ comp claim in Oregon should cover the cost of medical care and services related to your injury, including:
- Emergency room care
- Hospital visits
- Doctor’s appointments
- Required surgeries
- Rehabilitation and therapy
- X-rays and MRIs
Each and every workers’ comp case is unique. If you have been treated unfairly or had your medical treatment denied, our experienced lawyers at RGMR can help you navigate the process and determine which doctors and what treatments will be covered.
How to Increase the Chances of Your Workers’ Comp Claim Getting Approved
You can help to maximize the likelihood of approval by working with a qualified workers’ compensation and personal injury attorney. At RGMR, we know the ins and outs of the legal system in Oregon, and we can help fight for your rights and improve your chances.
Avoid making common mistakes when filing a claim.
One of the most common reasons for claim denials in Oregon and beyond is filing mistakes. Leaving out important details, neglecting to follow your doctor’s advice, and not advocating for yourself enough can all make it more likely that your claim will be denied.
Avoid making common workers’ comp filing mistakes and consider working with an experienced attorney to help improve your chances.
Related: 6 Common Mistakes to Avoid When Filing Workers’ Comp Claims
Prepare for your doctor’s evaluation.
Unfortunately, an unfair IME Report can hurt your chances of being approved for workers’ comp benefits. Taking steps to prepare for your doctor evaluation and advocating for yourself during the appointment can help limit the risk.
Related: How to Prepare For Workers’ Compensation Doctor Evaluation
What Are Your Options if Workers Comp is Denied?
If your claims are repeatedly denied, there are still private and public avenues that can help you finance your treatment, such as:
- Group health insurance
Facing Expensive Medical Bills To Treat Your Injury? RGMR Can Help!
If you’re suffering due to a workplace injury or illness, it’s easy to feel like the whole system is against you, especially if your claim has been unfairly denied. But you don’t have to do this alone. The attorneys at Ransom, Gilbertson, Martin, & Ratliff, LLP can help you build your case and get you the benefits you deserve.
With over 70 years of combined experience and a comprehensive understanding of Oregon workers’ comp law, we have what it takes to fight for your rights every step of the way. We’ll take the time to get to know you and the ins and outs of your situation and you won’t have to pay a cent unless we win your case.
Contact us today to get a free consultation.