What happens when Michigan workers’ comp doesn’t pay depends on what isn’t being covered — wage loss benefits, medical bills, or a settlement. Here’s how each situation works and what an injured employee can do.
What Happens If Workers’ Comp Doesn’t Pay Wage Loss Benefits In Michigan?
Late or unpaid wage loss benefits: If workers’ comp wage loss checks are due but not paid, here’s what happens: an employee or their attorney can ask the Michigan Workers’ Disability Compensation Agency to intervene, and a magistrate can order payment if benefits are owed.
Unpaid medical bills: If approved, work-related medical treatment isn’t being paid, providers or injured employees can dispute the denial through the work injury claim system.
Employer or insurer ignores an order: If an employer or insurer fails to comply with an order to issue payment, additional legal enforcement is available. Depending on the circumstances, this can include penalties, interest on overdue benefits, or court enforcement. (MCL 418.801)
Disputed claims: If the insurer denies a claim or stops issuing benefits altogether, an employee can file an Application for Mediation or Hearing with the state work injury agency. A magistrate will decide whether benefits are owed.
Why Insurance Companies Dispute Work Injury Claims
Work injury benefits are supposed to be a safety net for people hurt on the job, paid regardless of employee fault. All medical treatment should be covered without copayments or deductibles, and wage-loss benefits are paid at 80% of an employee’s after-tax average weekly wage. (MCL 418.321) These are potentially lifetime benefits.
Unfortunately, here’s what happens with many claims: insurance companies find all kinds of reasons to dispute and not pay workers’ comp claims in Michigan — late reporting, preexisting medical conditions, witness statements, failed drug tests, or alleged misconduct. Some clients never get a specific reason at all and are simply told the claim is “pending investigation.”
The Independent Medical Examination (IME) Problem
Many disabled employees find their claims disputed after attending a so-called “independent” medical examination (IME)“. Losing that exam often means losing access to medical treatment and weekly checks. These IMEs are performed by doctors selected by the insurance company, and the reports are frequently biased.
How to Challenge a Denied or Unpaid Claim
We strongly recommend challenging a disputed work injury claim rather than accepting a denial. An Application for Mediation or Hearing can be filed, and the matter goes before the state agency. (MCL 481.847) A magistrate will decide whether additional medical or wage-loss benefits should be paid.
It’s important to have a lawyer handle the hearing process — the rules of evidence can be difficult, and common sense doesn’t always prevail. There’s no attorney fee unless money is recovered, and it’s only a small percentage of what’s obtained.
What Happens — and What to Document — When Michigan Workers’ Comp Stops Paying?
If checks that should have been paid aren’t arriving, it’s important to document:
- The date the payment was due
- Any communication from the insurance company explaining the delay or denial
- Wage records and medical documentation
Other Options While a Work Injury Claim Is Disputed
Here’s what happens in Michigan when a workers’ comp claim is disputed: employers and insurance companies are permitted to stop paying medical and wage-loss benefits while the dispute is pending. It’s up to the injured employee to challenge the dispute and file for a hearing.
Employees can use their own private health insurance to cover medical bills in the meantime, including coverage through an employer. Medicaid or Medicare will also cover expenses. Reimbursement is required if money is later recovered through a work injury award or settlement, but in our experience that reimbursement is typically a small fraction of what’s ultimately collected.
Employees whose claim is denied may also be able to claim unemployment under specific circumstances, or make a claim through other coverage such as long-term disability. Reimbursement is typically required, but an experienced lawyer can minimize what needs to be paid back.
Not Sure What Happens If Workers’ Comp Doesn’t Pay A Claim In Michigan? Call Our Attorneys Now For A Free Consultation!
If you were injured while on the job in Michigan and are wondering what happens if workers’ comp does not pay or have any other questions regarding your claim, call now or fill out our contact form for a free consultation. There is absolutely no cost or obligation. Our attorneys are here for you.
Our attorneys have been exclusively helping injured workers in Michigan for more than 40 years. Our attorneys can help you better understand our state’s workplace injury laws. 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.
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.
Related information:
What Pays More Workers’ Comp Or Disability?
