If you go to your personal physician with a specific injury, one of the first questions you likely will face is whether the injury happened at work. There’s a good reason for the inquiry. If the trauma occurred outside of work, your personal or employer-sponsored health insurance receives the claim. If it was job-related, the claim goes to the company’s workers’ compensation insurer. Obviously, that difference in coverage influences claims processing and payment.
But often, when sitting in the doctor’s office, many workers are unaware of the scope of benefits workers’ compensation covers. This post is meant to help change that.
Medical benefits
Medical benefits are the most fundamental of benefits for eligible workers. If you are hurt on the job, workers’ compensation insurance covers the cost of medical care deemed necessary to treat the original injury or related illness. Except in the cases of necessary emergency treatment at an emergency room, the medical provider needs to be Workers’ Compensation Board approved.
If diagnostic tests are necessary, the workers’ compensation insurance company should pay for them too. However, services may be limited to organizations specifically contracted by the insurance carrier. Again, emergency room care is an exception.
The workers’ compensation insurance company will be billed for medications you are prescribed, at prices set in a Pharmacy Fee Schedule. New York state has medication guidelines that limit the type and quantity of medications that are covered.
Cash benefits
If you are temporarily or permanently disabled by the injury, you may be eligible for cash benefits. The timing of payments depends on the nature of the disability. The amount of payments depends on the degree of disability reported by doctors who have examined you.
Supplemental benefits
There are some instances where a permanent disability, or being a surviving spouse, entitle you to supplemental benefits.
Death benefits
Death benefits go to survivors of a worker who dies from a work injury. These benefits are payable to a spouse and/or surviving children. Funeral costs may also be paid.
Getting the benefits you are entitled to after you’ve been injured at work can be a difficult and complicated process, and the insurance company always has the advice of its lawyers working for them. Having your own law firm, working for you, will level the playing field and work to ensure that you are getting all the benefits you are entitled to. that you are getting all the benefits you are entitled to.
