Michigan lawyer explains how workers’ comp can pay for emergency room visits and what to do if bills do not get paid.
Many of our clients are seen at the emergency room immediately following a workplace accident. It is up to the employer to choose the medical provider during the first 28 days and it is only natural for the local ER to be selected. It is also possible that an industrial clinic will be chosen as these facilities specialize in treating injured workers. Many of our clients ask “does workers’ comp pay for emergency room visits in Michigan?” The answer is ‘yes’ and here are some things to know.
Workers’ comp is supposed to pay all reasonable and necessary medical bills including emergency room visits. There are no deductibles or copayments owed. The amount paid is controlled by a state-wide fee schedule and a patient cannot be charged any extra. It does not matter who was at fault just that it occurred in the course and scope of employment. All the employee must do is give notice of injury and request medical treatment.
It is the responsibility of the employer to make a workers’ comp claim with the insurance company. Sometimes this does not happen because the employer is trying to save money. They will lie about not having workers’ comp insurance because they don’t want insurance premiums going up.
Our experience also shows that employers don’t want to make a workers’ comp claim because they are afraid of getting caught violating safety rules. Promises from the employer to pay medical bills under the table are rarely kept. Never lie to a doctor about how the injury happened because this will jeopardize payment of future workers’ comp benefits. If an employer refuses to file a claim, an Employee’s Report of Claim (WC-117) can be filed with the State of Michigan and the responsible insurance company will be automatically notified.
Send a certified letter to the insurance company
Does workers’ comp pay for emergency room visits? Yes, but medical bills sometimes fall through the cracks. Insurance companies hate paying extra money so a certified letter asking for penalties usually gets their attention. Make sure to send a copy of the unpaid emergency room bill by certified mail return receipt requested so there is proof. Penalties can be sought if not paid within 30 days of notice of nonpayment. Employees can get up to $50.00 per day (or the amount of the bill if it is less) for a maximum of $1,500.00. There are no penalties if the claim has been disputed.
Does workers’ comp pay for emergency room visits if a claim has been disputed?
No, workers’ comp doesn’t pay for emergency room visits if a claim has been disputed. Unfortunately, it is not cost effective to file a lawsuit over a small unpaid medical bill. Sometimes the path of least resistance is a better option when this happens. Health insurance will cover a disputed medical bill in this situation. Reimbursement is usually required if money is ever recovered from workers’ comp.
File an Application for Mediation or Hearing
Does workers’ comp pay for emergency room visits? Yes, but sometimes a formal hearing is required. The employee can file an Application for Mediation or Hearing (WC-104A) and challenge nonpayment of an emergency room bill. These cases are typically scheduled for a telephone mediation and a representative from the State of Michigan will attempt to resolve the conflict. If it cannot be resolved, the matter will be placed on a pre-trial docket with a magistrate. Never attempt to proceed at the magistrate level without consulting a lawyer. Do not expect a magistrate to order payment of the emergency room bill using common sense. Just because an employee is right does not mean that he or she will win at trial. Specific procedures and the rules of evidence must be followed.
Michigan Workers’ Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 316-8033 for a free consultation today.