Will Going to the ER Affect Workers’ Compensation?

While a large portion of workplace injuries aren’t immediately life-threatening, there are also many that require emergency medical attention. This is a necessary step in recovering from your injury, but it may not always be clear how it will affect your workers’ compensation, especially given the expense of these visits. Workers’ compensation law is ultimately intended to cover the costs of medical treatment received for workplace injuries, so ideally, everything should work out in your favor.

However, it may not always be that simple. The main concerns with getting your emergency medical treatment covered is when it comes to your choice of doctors and the influence of your employer’s insurance company.

Choice of Doctors

Under Illinois law, you have the right to choose two doctors to provide treatment for your injuries. The care they provide (as well as that provided by doctors they refer you to) should be covered by your employer’s workers’ comp insurance. The exception is when your employer has a Preferred Provider Program (PPP). In this case, opting out of their network of doctors will count as one of your choices.

Whether or not your employer has a PPP or not, there is one question you might worry about when you need emergency medical care: Will that count against your choices of doctors?

The answer is, “No, it shouldn’t.” First aid and emergency treatment is covered in addition to that provided by doctors you choose, so it doesn’t count against that limit.

Additional Exceptions

In addition to emergency room treatment, there are other scenarios where the care you receive will not count against the two-doctor limit set by Illinois workers’ compensation laws. These include the following:

  • First aid received at the site of the accident
  • Treatment received before you had a chance to report the accident
  • Care from referred doctors, i.e. if your doctor refers you to a specialist, that doctor is also covered
  • Referrals from referred doctors

It is definitely possible to have all medical costs associated with a workplace injury fully covered, but there are a few items to take into consideration.

A Few Caveats

While state laws are largely favorable toward injured workers, there are a number of factors to beware of. These could make or break your claim, so it’s important to make sure you act carefully.

Perhaps most significantly, your employer’s insurance provider won’t want to pay any more than it has to. They may try to minimize your claim or make assertions that the injury wasn’t job-related (and therefore shouldn’t be covered) or didn’t constitute an emergency. If they can’t outright reject the validity of your claim, they may try to minimize it to get out of paying for further treatments, such as rehabilitative therapy or prolonged disability. They may send an IME doctor to verify the reports provided by your own physician.

If not handled properly, these factors could undermine your claim and result in you receiving less than what you’re owed. In these scenarios, you need an attorney to represent you and counsel you on the best route to take. Hart David Carson LLP can provide that legal assistance and ensure that you receive what you’re owed.

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