Conditions for Medical Care Under the Workers’ Compensation Act
September 15, 2017
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Welder at workAll employees in Alexandria, VA, are eligible for workers’ compensation benefits. Workers are required to report the injury to their employer as soon as possible and are also required to file a claim with the Virginia Workers’ Compensation Commission within two years of the accident. The company, once aware that a worker has been involved in a work-related accident and has incurred injuries as a result of that accident, is also required to report the accident to the Commission within ten days of becoming aware of the incident. Any failure to follow these reporting guidelines can result in negative consequences for both the employer and the employee, ranging from claim denial to penalties for the employer according to the workers’ compensation act.

The types of injuries covered by the workers’ compensation act include:

  • injuries that occur at work or during a work-related event;
  • injuries that are caused by a specific work activity;
  • injuries that happen suddenly.

It is important to note that workers’ compensation does not cover injuries that are a result of repetitive trauma. However, diseases that may be the result of such repetitive trauma may be covered if the work causes them and if they are not related to the back, neck or spinal column.

What Medical Care is Covered by the Workers’ Compensation Act?

As far as medical care is concerned, workers’ compensation benefits cover all medical expenses that the worker incurs for treating the work-related injury. These medical expenses will be paid for by the employer’s coverage for as long as it is necessary. However, there are certain conditions that the employee must follow to ensure this happens:

Find answers to your questions about the workers’ compensation act when you reach out to Ashcraft & Gerel.

  • The employee has to file the claim within the specified time period, only then the benefits will begin for an injured party.
  • The employee has to select a doctor from a panel of physicians that the employer and the employer’s insurance company have already approved. In Virginia, the workers’ compensation act requires the employer to have three physicians on this panel.
  • If the doctors on the panel are unavailable at the time of the accident, and if you require immediate care, you can seek treatment from any physician. You can also continue treatment with another doctor or specialist if the treating physician refers you to them. This is an exception which is acceptable as per the law, but once you begin treatment with this physician, you cannot change your doctor unless you have approval from the employer and their insurance carrier or, in some cases, the Commission.

The employee should cooperate with the employer concerning these conditions; otherwise, there is a chance that their medical benefits may be delayed or suspended.

Keep in mind that the employer is liable for your treatment, even if its for the lifetime of the employee unless the employee relinquishes this right through certain actions or settles the claim. This obligation to cover the worker’s medical costs begins as soon as the injury occurs. The employees simply have to follow the procedure and need to ensure they consult doctors on the panel only (unless they are unavailable). The employer has to ensure that these three physicians are not in the same practice group but are from different, but relevant, medical segments.


Workers’ Comp Disputes Related to Medical Expenses

Complications can arise if the employer has an issue with the level of injuries that the worker has incurred. This can happen if the worker had a pre-existing condition and the employer argues that the injury is related to that condition and not to the work-related accident. Alternatively, the employer could have an issue with how the accident occurred and questions whether the injuries were related to the work or not.

All these factors can make the approval process complicated, but one thing that you should know is that if the attending physician gives their diagnoses and prescribes treatment, the employer has to cover the medical costs unless it is obvious that the injuries are not work-related. That is why it is important for workers to not only report the accident but also to provide as much detail as possible about the injuries. It is also important for workers to seek medical treatment even if they consider the injury to be minor. The doctor is the best person to determine the level and extent of the injury and the proper treatment protocol.

Overall, workers’ compensation benefits will cover the cost of treatment and rehabilitation as needed for workers who sustain injuries in the workplace or while doing a work-related activity. However, as previously noted, employers may not want to be liable for such costs, especially if the treatment is expected to continue for a long period of time. The employer and their insurance carrier will try to find ways to go around it so that they can either not pay you at all or minimize the payout.

If you have injuries as a result of an incident at the workplace and if you need medical treatment, as a result, your employer should cover your medical expenses. If your employer is making the process difficult or if the employer is challenging the diagnosis or the duration of the treatment, you need to seek legal counsel. A workers’ compensation attorney will be able to advise you on how you should proceed and what possible avenues you have to ensure you claim is approved and your benefits are not delayed.

Schedule a Consultation with a Workers’ Compensation Attorney Today

If you need an attorney, contact us at Ashcraft & Gerel. We have a team of lawyers who have dealt with numerous workers’ compensation claims. We understand that when you suffer an injury, you not only have to deal with the physical consequences of that incident but you also have to deal with lost wages, stress, and family pressure. You deserve to put your mind at ease and use this time to recover from your injuries so that you can go back to work and start providing for your family again. Call us today at (866) 709-0505 and one of our associates will be able to help you with all your concerns and queries related to the workers’ compensation act.