Medical Benefits for Workers Compensation

If a worker meets the threshold of a compensable case, the worker has a variety of rights to workers compensation benefits. The worker can be medical treated for his work-related injuries can include but are not limited to doctor visits, nursing charges, hospital charges, surgical charges, prescription medications, prosthetic devices, medical supplies, physical therapy, reimbursement for milage traveled to seek medical treatment. However, insurance company will not randomly pay for all treatment recommended by a doctor.

The insurance company will suspect and may deny to pay medical treatment for any of following reasons:

1. There is a new injury or accident;
2. The treatment may not be causally related to the workers compensation accident;
3. The treatment is excessive, expensive, or not reasonable; or
4. According to one of the doctors, the worker has reached maximum medical improvement.

In many instances, an employer will request from the treating doctor a recommendation which sets out a road of map of the proposed treatment. There are times where the insurer will request the worker to perform an independent medical evaluation to find out if should pay for the medical treatment. This independent medical evaluation will figure out whether the insurer will continue to pay for the medical treatment or deny the medical benefits to the worker. In a very few cases, the Maryland Workers Compensation Commissioner will request a medical evaluation. The medical providers have to follow a fee schedule that sets out compensation for the medical providers for work done. The fee schedule must be followed by the medical providers when it comes to accurate payment. It may be difficult for the injured employee to find a provider outside the state to accept the fee schedule when it comes time to treat the injured employee. The medical providers who do not practice medicine in the state of Maryland will probably not accept the fee schedule and not treat the injured employee because they are not familiar with the Workers Compensation Procedures in Maryland.

If the insurer denies medical treatment to the injured employee, what need to be done in the case is that issues need to be filed with the Maryland Workers Compensation Commission to schedule the closest available hearing where issues can be determined by the Maryland Workers Compensation Commission. When you have a hearing before the Commissioner, the Claimant and/or the attorney should have an outline of the treatment present to the Commissioner which is proposed as well as a communication of causal relationship if needed and why the medical treatment is relevant at the time if injury for which issues are being heard. The employee’s medical provider must go into details into the facts because the insurer will bring up defenses to the medical treatment which will be brought up in the hearing. The insurer will bring with them a defense medical evaluation which will allege that the medical treatment is not causally related, not necessary or reasonable or that the employee has reached maximum medical improvement and should not receive additional medical benefits.

As your Frederick Worker Compensation Attorney for documenting your work-related injuries, the Law Firm is here to serve Frederick, Montgomery, Washington, and Carroll Counties as well as the remaining Maryland area. The Firm would like to be your Workers Compensation Lawyer for documenting your work-related injuries. You can contact the Soubra Law Firm at 301-219- 5038 to discuss your Workers Compensation case for free.