Michigan lawyer explains how workers’ comp should pay for emergency room visits and what to do if medical bills do not get covered.
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.
Does workers’ comp pay for emergency room visits in Michigan?
In Michigan, workers’ comp is supposed to pay for all reasonable and necessary medical bills including emergency room visits. There is no deductible or copayment. The amount paid is controlled by a state-wide fee schedule and a patient cannot be charged extra. It does not matter who was at fault just that it occurred in the course and scope of employment.
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.
What happens if they don’t pay?
Medical bills sometimes fall through the cracks and get left unpaid by insurance companies. For any unpaid emergency room bill send a certified letter asking for penalties. bill. Make sure to also send the copy of the bill by certified mail return receipt requested so there is proof.
Insurance companies hate paying extra money so a certified letter asking for penalties usually gets their attention. 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.
Does the emergency room drug test for workers’ comp in Michigan?
In Michigan, sometimes employers pay for drug and alcohol testing at the initial emergency room visit because an employee who was intoxicated does not qualify for workers’ comp benefits. Watch out for insurance companies who use a positive drug test to dispute all benefits regardless of intoxication.
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.
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 correctly followed. It is also possible that an employee is leaving money on the table because they don’t understand their legal rights.
Injured on the job? Call our work injury attorneys now for a free consultation!
If you were injured on the job in Michigan and are wondering if workers’ comp will pay for the the emergency room visit, call now to speak with an experienced work injury lawyer, or fill out our contact form for a free consultation. There is absolutely no cost or obligation. We’re here for you.
For more than 40 years, our lawyers have been helping people like you who have suffered from work-related injuries in Michigan. We understand the physical, emotional, and psychological hardships you are experiencing from your accident. We also have the skill, experience, and know-how to protect you and get you the best possible payout amount for your case.
To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.
Remember, every work injury claim is different and must be negotiated on its own merits. Do not accept any payout amount without fully understanding your legal rights.
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 40 years. Call (855) 221-2667 for a free consultation today.
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