How Do I Get My Workers’ Compensation Medical Bills Paid?

Recovering medical bills when you’ve sustained an injury while doing your job is possible thanks to Pennsylvania’s workers’ compensation laws. Yet, many employees find the workers’ compensation system confusing or feel anxious about seeking the medical care they need. This guide will help you navigate workers’ compensation and medical billing so you can approach your recovery with confidence.

Who Pays Medical Bills if I Get Injured at Work? 

In most cases, your employer’s workers’ comp insurer pays your related medical bills if you get injured at work. Most Pennsylvania employees fall under the Workers’ Compensation Act of 1915. This law requires almost all employers to carry insurance and pay out workers’ compensation claims for medical expenses and lost wages. 

The insurer must pay your medical bills after a successful workers’ comp claim if those costs are reasonable and necessary because of your workplace injury. You or your private health insurer should only pay if you seek care unrelated to your injury, you’ve recovered or your workers’ comp claim has denied payment of the bills. 

How Do I File a Workers’ Compensation Claim to Pay for Medical Expenses?

As a Pennsylvania employee, you can file a compensation plan for your on-the-job injury and get your medical bills paid by taking these five steps as soon as your injury happens.

1. Inform Your Employer

For your workers’ compensation claim to succeed, you must report your injury to your employer within 120 days and say you intend to claim workers’ compensation. It’s best to report it immediately, though, as this can entitle you to start receiving benefits sooner and give you more time to handle any challenges you encounter along the way.

Sometimes, your employer’s insurer requires you to provide additional evidence or you need to appeal their decision. Starting the process earlier allows you to get over those speed bumps and receive your benefits as soon as possible.  

2. Confirm Your Employer Reports the Injury

As soon as you tell your employer about your injury, they should file a First Report of Injury (FROI) form with the Workers’ Compensation Bureau. They must submit this form within seven days of your first missed workday due to injury, so follow up if necessary to ensure they do so. Your employer should also inform their insurer of your claim during this time. The insurer will either accept and pay out your benefits, deny your claim or ask for additional evidence to process it. 

3. Get Medical Attention

Depending on the severity of your injury, this step may be even more urgent than informing your employer. If you get urgent medical care related to your work injury before the insurer processes your claim, you can receive compensation after filing a successful claim by submitting a copy of the bill to the insurer and requesting reimbursement. A workers’ comp attorney can help you fight for reimbursement if they refuse to cover a medical bill related to the injury you successfully claimed for. 

At your initial appointment, you should be prepared to provide at least:

Your employer’s name, phone number and address.

Their workers’ compensation insurance carrier’s name, phone number and address.

A description of where and how your injury happened.

An account of your pain and other symptoms arising from the work-related injury.

The records from this initial medical appointment provide important evidence supporting your claim. At follow-up appointments, after you’ve filed your claim, you should give your physician:

The injury date and workers’ compensation claim number.

A notice of compensation payable (NCP), notice of temporary compensation payable (NTCP) or a workers’ comp judge’s award recognizing your work-related injury.

Every time you get medical assistance for your injury, ensure your physician and their billing staff understand you are seeking treatment specific to your work-related injury, and ask them to submit your bill to the workers’ comp insurer. If the insurer denies a medical bill claim stemming from an on-the-job injury, a workers’ comp attorney can help you appeal the decision and make your case in court if necessary. 

4. Contact an Attorney

Getting legal help with your workers’ comp claim is highly advisable. A workers’ comp attorney can help you gather the evidence you need, follow up with your employer and their insurer, stay ahead of the deadlines and handle any disputes. 

If the insurer rejects your initial claim or any medical bills, a seasoned attorney can guide you through the appeals process and stand up to the insurance company’s lawyers if the dispute goes to court. Should you receive a settlement offer in place of continuing medical bill coverage at any point, your attorney can also help you evaluate it and negotiate in your best interests. 

5. File a Petition if Necessary 

In some cases, you need to get a little more hands-on to receive workers’ compensation and get your medical bills paid. Within three years of becoming aware of your injury, you can file a claim petition with the Workers’ Compensation Bureau if you have not received compensation. This may be necessary if:

Your employer refuses to file an FROI and request your compensation from their insurer.

Your employer disputes the reason for or severity of your injury.

The insurer denies your claim.

If the workers’ compensation judge does not award you compensation in response to your petition, a workers’ comp attorney can help you evaluate your case, prepare evidence and pursue the appeals process further.

Does Workers’ Comp Cover All Medical Bills?

Not necessarily. After a successful claim, workers’ comp pays medical bills only as long as:

They are necessary, reasonable and related to your injury. 

You comply with any request by your employer to see a health care provider they designate on a list of six or more options for the first 90 days after your initial appointment. 

You have yet to achieve medical recovery with no restrictions according to an agreement or the decision of a workers’ comp judge.

You have not yet fully recovered from the work injury, even if you have returned to full, pre-injury employment or gained the ability and opportunity to do another job for the same pay or better.

Contact Frommer D’Amico for Legal Help Getting Workers’ Comp to Pay Medical Bills

If you’re injured while doing your job, getting your medical bills paid through workers’ compensation should be simple. In reality, managing deadlines, gathering evidence and sometimes overcoming resistance from your employer, their insurer or hard-nosed insurance company lawyers can feel far from straightforward. For reliable help navigating workers’ comp medical bills, turn to Frommer D’Amico.

John Frommer and Joe D’Amico are certified workers’ comp attorneys with over 40 years of experience each. These seasoned attorneys advocate for you to get the compensation you deserve, offer personalized legal support with 24/7 accessibility and provide free case management. Frommer D’Amico wants you to get your money for medical bills, not to spend it on case management, so you’ll only pay for legal help if our firm wins your compensation.  

Request a free consultation for help getting your medical bills paid.