When you are injured on the job, your employer’s workers’ compensation insurance coverage provides benefits that can include medical care and ongoing treatment. Your employer (and its insurance carrier) assigns one or more appropriate treatment providers for your medical needs (e.g., an orthopedist, physical therapist, or other skilled professional). Rather than reimbursing you for out-of-pocket payments, the carrier handles payment directly, and you don’t have to worry about bills.

What Kind of Care Is Provided by Workers’ Comp?

Your employer and its insurer are responsible for providing and paying for all reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance, and hospital services and supplies, plus reasonable and necessary transportation expenses for you to obtain that care. You have the right to receive prompt care that is reasonably suited to treat your injuries without being unduly inconvenient for you.

However, some injuries require immediate emergency care. Others have recurring symptoms or ongoing conditions that can necessitate a more urgent response than making a regularly scheduled appointment with an assigned care provider. In those cases, will workers’ comp reimburse you for your emergency care?

Workers’ Compensation Covers Necessary Emergency Care

If you suffer a life or limb-threatening emergency situation, such as broken bones, profuse bleeding, head injuries, wounds that require stitches, severe burns, chemicals in the eye(s), etc., you should get immediate emergency treatment from an appropriate, available provider without waiting for authorization. Workers’ compensation will reimburse you for emergency medical care expenses so long as they were work related. All medical treatment expenses, including those for emergency care, will only be covered by workers’ compensation if the injury/illness is determined to have arisen out of and in the course of employment, meaning that you were engaged in work activities when the injury occurred or developed and the nature of those work activities contributed to the injury’s development.

Obtaining Reimbursement for Unauthorized Care

The safest way to ensure you obtain reimbursement for emergency expenses is to contact the insurance carrier or your employer and obtain authorization before you see a provider, but sometimes that isn’t possible or practical. Iowa workers’ compensation case law makes clear that “an employee generally may recover medical expenses incurred in seeking unauthorized care upon proving by a preponderance of the evidence the care was reasonable and beneficial under the totality of the circumstances.”[3] However, the process of disputing a workers’ compensation denial of coverage can be challenging. Having an experienced workers’ compensation attorney on your side can help you recover the benefits you deserve for your work-related injury.

If you are unsatisfied with your provider or believe you need additional care that your employer will not authorize, you must make a request in writing to your employer; if that doesn’t resolve your issues, you may have to appeal to the workers’ compensation commission. A workers’ compensation attorney can help you through this process to ensure you get the care and coverage you deserve.

Workers’ Compensation Attorneys for Iowa Employees

A workers’ compensation attorney is your advocate and partner through the complicated and often confusing workers’ compensation process. If you have been injured at work, contact the Platt Law Firm today. We will review the facts of your situation and help you figure out whether you may be entitled to workers’ compensation benefits for medical expenses, lost wages, temporary or permanent disability, or other covered expenses.

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