Massachusetts Workers Compensation - Medical Benefits
You could find yourself fighting with increasing medical bills and finding out no way to pay for your treatment if you were injured or became ill on the job. Your disability, whether permanent or temporary, can prevent you from working for an extended period resulting in lost wages, or it may restrict the type of work you can do and the amount of income you can earn.
The Massachusetts Workers' Compensation Act offers disability benefits to cover medical expenses incurred when treating a work-related injury or illness. Workers' compensation does not substitute health insurance; rather, it replaces it by serving as the sole source of payment for treatment of a work-related illness or injury.Who is Entitled to Medical Benefits in a Massachusetts Workers’ Compensation Claim?
If you are seeking medical benefits as a result of a work-related accident or illness, you are entitled to workers' compensation benefits. For the period of your condition, you will receive what is called adequate and reasonable medical care. This covers all hospitalizations, operations, rehabilitative treatment, and doctor's appointments. You can also be reimbursed for prescription drugs as well as miles for travel to and from appointments.
You must seek medical attention as soon as possible if you have suffered from a work related illness or injury. Additionally, you should notify the employer as soon as possible so that it may notify its insurer and the Department of Industrial Accidents (DIA). When you report it, the insurer will give you a claim number and create an insurance case for you. From there, your insurer will charge it directly for your treatment and obtain any requisite pre-approvals.
Your employer's insurer has the right to select a healthcare provider for your initial physical or medical visit, but you will then have the ability to choose your provider. The insurer can even send you to its provider regularly to determine your illness or injury. This may raise concerns about what constitutes reasonable and adequate treatment, both at the outset of the disorder and along its course.What is a Work-Related Illness?
Work-related illness can take many forms and can be caused by occupational exposure to toxic substances or other toxins, as well as viruses and bacteria in some cases. For example, Mesothelioma is a common workplace illness that we deal with at Bellotti Law Group P.C. Mesothelioma is almost often caused by asbestos exposure.
If someone inhales asbestos dust, fibers may become trapped in the mesothelium, a layer of tissue that lines the thoracic cavity, abdominal cavity, and heart sac. These fibers will eventually spread and cause a deadly type of cancer known as mesothelioma, lung cancer, or other respiratory illness.
Asbestos contamination at work is the leading cause of mesothelioma. Construction workers, firefighters, factory workers, power plant workers, and shipyard workers are all at risk of contracting mesothelioma, in addition to other dangerous respiratory illnesses. To minimize the risk of exposure, Personal protective equipment, like respirators, should be worn by those working in or near asbestos.
Coverage for such occupational illnesses can vary depending on whether the employee is routinely likely to come into contact with a certain virus or bacteria and what precautions the employer has taken to protect workers. Tuberculosis, which is becoming more common in urban areas across the world, is one recent example, as is the novel coronavirus, also known as COVID-19, which has killed thousands of Massachusetts people.
First responders, such as police and firefighters, and essential workers, such as health professionals, care home workers, and local supermarket workers, are at greater risk of acquiring COVID-19.What is Considered Medical Benefits?
As discussed, workers who are injured or become sick as a result of their job are entitled to compensation for sufficient and reasonable medical treatment, medication expenses, and travel reimbursement for travel to and from a healthcare provider.
According to M.G.L. c.152, 13; “the insurer shall furnish to an injured employee adequate and reasonable health care services, and medicines if needed, together with the expenses necessarily incidental to such services.” The question is what is considered medical benefits. Emergency room visits, hospital stays, medical tests such as X-rays, and some physical therapy are usually accepted as adequate and reasonable treatment and should be protected by the workers' compensation benefits.
Other forms of medical treatment, on the other hand, could be called into question and compensation for these expenses denied. Here are some examples:
- Psychiatric care
- Experimental treatments
- Advanced medical devices
- Alternative treatments such as acupuncture, chiropractic treatments, and relaxation therapy
Your workers' compensation lawyer will advise you about the various types of medical treatments that are likely to be covered and can protect you if medical benefits are wrongfully refused.Choosing Your Doctor
Your employer has the right, under EOLWD regulations and Massachusetts law, to designate where their workers first undergo medical attention after a work injury. However, after the initial procedure has been completed, the injured worker can be treated by any healthcare facility that receives workers' compensation benefits.
An injured worker has the right, under M.G.L. c.152, 13, to choose his or her doctors and other health care providers, as well as discretion of his or her medical treatment. The insurance company can from time to time request an injured worker to be treated by a doctor of the insurer's choice.
One of the most common concerns we hear from our workers' compensation lawyers is why injured workers would pay for medical costs out of pocket. Any injured workers pay themselves in the hope of eventually being reimbursed by a medical benefits award. If you get bills in the mail, the medical center is most likely paying the incorrect insurance company. Both medical treatments should be covered by the workers' compensation insurance company, with no out-of-pocket costs.
The employer's insurance company is mandated under Massachusetts workers' compensation law to provide wounded employees with an insurance card containing a claim number and contact details. The injured worker will then show their medical benefits form to the hospital provider they are seeing, who will then contact the workers' compensation insurance carrier directly. Further, any prescriptions involved with your care should still be covered by your workers' compensation insurance company.
Many injured workers wonder how much longer they will have to wait for workers' compensation medical benefits. Injured workers in Massachusetts are entitled to medical benefits for as long as they need medical attention and treatment. However, under some circumstances, workers may be entitled to permanent medical benefits for the remainder of their life.Consult with a Massachusetts Workers Compensation Attorney
When your employer wants you to use your health insurance after a work-related illness, you can consult with a workers' compensation attorney at Bellotti Law Group P.C. as soon as possible. Call 617-225-2100 for a free consultation today.