Workers Comp and Health Insurance

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Workers Comp and Health Insurance Cases

Using health insurance in Workers Comp cases

If you have been injured on the job in Maryland than you may be wondering if you can use your health insurance rather than going through the workers compensation process.  Perhaps the workers compensation insurer has denied your treatment, or perhaps they are attempting to control the doctors with whom you treat by not authorizing medical treatment.  The process can make you feel very uneasy and confused because Maryland workers compensation laws are not easily understood, and with this confusion injured employees are likely to question whether they should even pursue workers com benefits.  The question may then arises-can the injured worker use health insurance in workers compensation cases?

Health insurance and Workers’ Compen Insurance

To better understand workers compensation in Maryland it is helpful to view the workers compensation Insurer as another health insurer similar to Blue Cross or Cigna.  Workers Compensation Insurance is not accepted by all physicians just as your health insurance may not be accepted by all physicians.  Do not interpret this as the Workers Compensation Insurer having the control to send you to only certain doctors. Maryland workers compensation adjuster will sometimes provide a doctor on their “list” that you are able to see.  They may phrase it as “you can go and see Doctor X,Y, or Z.”This is not in accordance with the law.  YOU and the DOCTOR of your choosing control the situation and you are only excluded from seeing certain doctors if those doctors do not accept workers compensation insurance.  Liken this to a doctor not accepting Cigna, Blue Cross, etc.

Use of Health Insurance in workers comp cases 

The Insurance provider that is obligated to pay for your treatment is determined by the circumstances of the injury.  If the injury took place at work while performing work duties then the health insurer is not obligated to pay for treatment and payment and authorization should be obtained through the workers compensation insurer.  This determination is made at the first medical appointment when the explanation of injury is described to the doctor.  Best practice is to use the work comp insurance for injuries sustained at work.  There would be no co-pays, no deductibles, paid reimbursement of mileage to and from the doctors, and better pay rates for the doctors in circumstances.   With that said there are certain delays that the injured worker will likely endure when treating under workers comp insurance.  If delays are the issue then it is time to obtain a Maryland Workers Compensation attorney that is qualified and experience to handle your case.

Occasionally the health insurance company will pay for treatment and later look for reimbursement from the workers compensation carrier.  This is their obligation under Maryland law when workers comp denies treatment.  Again, if workers comp denies medical treatment then health insurance can be used for treatment under the workers compensation case.  The work injury case can become more complicated for all parties involved if health insurance is used however timely medical treatment is very often the priority.  Complications may include the injured Maryland worker paying co-pays which can quickly ad up, the injured worker will have expenses which are not ordinarily present when using workers compensation insurance, the health insurer will have to deal with the workers comp insurer and fight to get reimbursed, the workman’s comp insurer will have to review all past medical reports and records and issue payments to the providers accordingly which could be very timely.

As a side note:  If your supervisor is attempting to influence choice of insurance you use they may be doing it for their own benefit.

Workers Comp and health insurance after settlement

Many injured workers quickly become tired and frustrated with the workers compensation process and just want to settle their case and “be done with the whole thing.”  While this is not always advisable it can often be the best thing for all parties involved.  In the event your workers compensation claim is settled the health insurer will then be required to provide treatment to the body part injured.  It is important to know that health insurance will step in and pay the medical bills in the event that the workers compensation claim is lost however the injured worker may then be obligated to pay past co-pays and deductibles.

Use of Health Insurance (Medicare) in workers compensation cases

The use of Medicaid in workers compensation cases can cause substantial complications for the injured worker, workers comp, and the attorneys involved in the case.  It is best to avoid using medicare for any injury that arose at work.  In the last few years the Federal Government has focused on obtaining reimbursements for payment of medical treatment that ultimately was the responsibility of another insurance entity.  In particular the Center for Medicare and Medicaid Services is actively seeking repayment in workers compensation claims.  Should any particular workers compensation claim settle without first considering the interests of Medicare/Center for Medicare and Medicaid Services the end result could be devastating for all involved.  Prior to using Medicare for workers compensation treatment the injured worker should contact an attorney for a free consultation.


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Maryland workers compensation attorney Andrew M. Rodabaugh and his office offers information about Personal Injury law and Workers’ Compensation for informational purposes only. Nothing contained herein constitutes formal legal advice. If you need the advice of a Maryland workers compensation lawyer, please contact him today. He has offices throughout the state and various convenient meeting locations.  Each and every case needs to be evaluated before legal advice can be provided.  Under no circumstance should the information on this website be considered medical advice. This is an attorney’s website and is not affiliated with any government agency or government entity of any kind.
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