Group Health Insurance Can Cover Your Medical Care While Your Case Is Pending — But Should Not Replace Workers’ Compensation
One of the primary benefits under Michigan workers’ compensation is access to medical care: You are entitled to unlimited medical treatment for your work injury. We’ve provided information below about what to do if your insurance company or employer refuses to pay your medical bills under work comp.
Q. What insurance can I use if work comp refuses to pay for my medical benefits?
A. One of the primary benefits under Michigan workers’ comp is access to medical care. You are entitled to unlimited medical treatment for your work injury.
Many people want to know who will pay their medical bills when workers’ compensation has refused. It is possible to have your own group health insurance or the group health insurance of a spouse pay for your medical treatment. This will allow you to continue with medical care and recovery while you are pursuing workers’ compensation benefits in court.
Q. Why would my work comp medical benefits be disputed?
A. All reasonable and necessary medical should be paid under workers’ compensation. Some employers and insurance companies will dispute paying medical because they do not want to accept responsibility for an injury.
Q. Will my group health insurance pay my disputed work comp medical bills?
A. Most group health insurance companies will agree to pay disputed medical bills when you have a pending workers’ compensation case.
You may need to provide a formal document entitled Notice of Dispute. You may also have to sign a reimbursement agreement and pay them back out of the proceeds of any settlement or award. Blue Cross Blue Shield of Michigan is in a special category and the law requires payment of disputed medical bills pending resolution of a workers’ compensation case.
An experienced workers’ compensation lawyer can negotiate with your group health insurance company to reduce any reimbursement amount. The goal should always be to maximize the amount of money that you receive from workers’ compensation. We have had group health insurance companies take pennies on the dollar as part of a workers’ compensation settlement.
Q. What if group health insurance is not available?
A. There are other options if group health insurance is not available. You may be able to obtain health care coverage through Michigan Medicaid. This is a state program that assists individuals with low income and limited assets by providing health insurance.
You will be expected to pay Medicaid back for any medical treatment that should have been paid through workers’ compensation. Medicaid pays low rates and it is sometimes difficult to find a doctor who will accept this form of insurance. You might not be able to get all the medical treatment required for your injury.
Medicare is a type of health insurance provided by the federal government for people who are disabled. You will receive Medicare if your are approved for Social Security disability benefits. But there is a 29-month wait period after your disability date. Medicare is accepted by most doctors and hospitals. Medicare will conditionally pay when workers’ compensation will not. You must reimburse Medicare for any conditional payments that are made if you are successful in your workers’ comp case.
Q. Does using other insurance replace work comp medical care?
A. While using other health insurance is an option to get medical care, it should not replace workers’ compensation. You will not have any co-pays or deductibles under workers’ compensation. Your medical treatment is unlimited and can be paid for life.
Do not let your employer tell you to use your own health insurance instead of workers’ compensation. This is not correct and shifts the costs of medical care to parties who are not responsible for your work injury.
Have Questions About Who Is Going To Pay Your Medical Bills?
You don’t have to suffer in silence without any income or medical care just because your insurance company or employer don’t want to take responsibility for your injury.
We will take all the time you need to answer your questions. And we can do what it takes to make sure you receive all of the work comp medical benefits you’re entitled.