What Medical Expenses Are Covered by Workers’ Compensation?

If you have been injured while doing your job, you have a right to claim workers’ compensation benefits. Part of these benefits is your medical expenses resulting from your injury will be paid for. However, there are a few qualifications that need to be met, and in some cases, these can make the difference between getting coverage and having your claim denied.

Fortunately, under Illinois law, there aren’t too many limitations on what expenses will qualify for workers’ comp, but denial of claims do happen, and it’s important to know what you’re entitled to. Here, we’ll look at some of the main factors that go into determining whether your medical expenses are covered.

Choice of Doctors

First of all, Illinois workers’ compensation law puts some restrictions on your choice of doctors. Generally, you are permitted to choose any two doctors to provide treatment, but if your employer has a preferred provider network and you opt out of that network, you are limited to only one. Only the doctor(s) you choose and direct referrals they give you will be covered—treatments given by other healthcare providers will not, so you’ll generally have to pay for those yourself.

Related to the Injury

The second of these qualifications is that the medical treatments you receive must be related to your injury. If, for example, you broke your arm while on the job, but receive treatment for your high blood pressure, that portion of your expenses that went toward your blood pressure won’t be covered by your employer.

Reasonable Treatment

Thirdly, the treatment must be considered to be “reasonable.” This is pretty straightforward in most cases. For example, if upon breaking your arm your doctor set it and put it in a cast, that will almost certainly be covered since it’s a commonly accepted way to treat that injury. On the other hand, if you went on to get acupuncture to help alleviate the pain, that will be less likely to be covered since it’s not a commonly accepted medical practice. As such, it wouldn’t be considered to be “reasonable” under Illinois worker’s comp law.

Other cases could go either way. For example, if you were prescribed the use of a specialized orthopedic pillow for neck pain resulting from an injury, it could be argued to be “reasonable” treatment, and thus could be covered. You’ll need to be able to persuade your employer and their insurance company of that fact, however.

Good Workers’ Comp Attorney

Some cases are ambiguous, and you might get denied coverage that you actually deserve. In these cases, a skilled workers’ compensation attorney is another vital factor in determining what medical expenses are covered. Taking the abovementioned example of the orthopedic pillow, your attorney can help make sure it is covered by your worker’s comp benefits.

If your workers’ compensation claim looks like it could go either way or if your employer blatantly tries to give you less than you deserve, contact the workers’ compensation attorneys at Hart & David today to make sure your rights are protected.

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