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Does Workers’ Comp Cover Emergency Room Costs?

emergency room entrance at nightIf you get injured on the job and need immediate medical care, the first place to go is the emergency room. They are always open and prepared to handle most medical situations. However, will workers’ comp cover your emergency room costs? The last thing you want is the sticker shock of an unexpected medical bill while trying to recover from your injuries.

At Jay Trucks, we have a solid understanding of workers’ comp laws in Michigan. This expertise comes from years of representing the injured, including employees who got hurt on the job. Our firm has recovered over $500 million for injured victims throughout the state.

After a work injury, we are prepared to help you get the compensation and benefits you need. Call our firm to learn more at no cost or risk to you. Our intake staff are available to take your call 24/7.

Call for a FREE case review 989-244-0356

Will Workers’ Comp Cover My Emergency Room Bill?

Under Michigan’s workers’ compensation law, you should be covered for all reasonable medical costs related to your injury. This includes going to the emergency room immediately following the accident that caused your injury.

Additionally, you should not be charged anything over the costs charged to your workers’ comp insurance carrier. For workers’ comp claims, the fees paid to medical facilities are set forth by a fee schedule controlled by the state.

That said, it is important to mention that after the initial emergency room visit, you will need to see the doctor your employer chooses for the first 28 days of your care.

Do I Have to Prove Who is At Fault for My Injury?

In a Michigan workers’ compensation claim, you do not need to prove fault. These benefits are generally available to you regardless of who was at fault. That said, you do need to prove that the injury was due to, or caused by, your job. If your injury is not work-related, then you will not qualify for workers’ comp. Workers’ comp would not cover your bill for the emergency room in that situation.

What if I Get a Bill for My Emergency Room Visit?

Sometimes the hospital may send off a bill before it is clear that you are being cared for under a workers’ compensation claim. If this happens, there are a couple of steps you can take to help trigger payment for this bill:

  • Notify your workers’ comp insurer about the ER bill you received
  • Make sure this notification is sent in writing and via certified mail so you have proof
  • If the insurance company does not pay the bill within 30 days, you can request payment of penalties

Workers’ comp insurance carriers have 30 days after notification of a valid bill to pay up. If they fail to pay, they can be assessed up to $50 per day or the full amount of the bill, whichever amount is less. The maximum penalty they can owe per bill is $1,500.

Will Workers’ Comp Pay My Emergency Room Costs if My Claim is in Dispute?

Unfortunately, no. If your claim is being disputed by either your employer or workers’ comp carrier, your ER bill will not be covered.

In this situation, you can simply submit the bill to your health insurer. They will cover an ER bill if your workers’ comp claim is in dispute. If your claim is later approved and workers’ comp reimburses you for the ER bill, you will also need to pay back your health insurance carrier.

Should I Accept A Cash Offer From My Employer to Pay My Medical Bills?

Absolutely not, as this never works out in the employee’s favor. Typically, employers only offer to pay up front to protect themselves. For instance, they may want avoid being caught for safety violations in the workplace or prevent their insurance premiums from increasing.

Often, this type of “under the table” payment could also come with strings attached. For instance, the employer may ask you to lie about how the accident and your injury happened. While this may not seem important, it could risk your ability to get workers’ comp benefits in the future.

If your employer simply refuses to file your claim without a valid reason, you can complete form WC-117 and file it yourself. We also strongly recommend that you seek legal help in this type of situation to protect yourself and your benefits.

Are There Legal Options for Getting My Emergency Room Bill Paid?

There are legal options you can seek to help you to get your ER bill paid. However, it is a good idea to have an attorney help you through this legal process.

You will have to first file an application using the state’s Application for Mediation or Hearing – Form A. This hearing provides a legal opportunity to challenge your employer’s refusal to pay your emergency room bill.

The first phase of this process is mediation with a state representative. After receiving your application, a representative from the state will contact you to try to resolve the issue of non-payment. If mediation is not successful, there are other options you can seek.

The next phase is considerably more difficult as you will be placed on a pre-trial docket with a magistrate. You should not attend this meeting without first seeking legal help. A licensed attorney knows how these hearings proceed, what is needed to help ensure success for the victim and what rules must be followed.

Call Our Firm Legal Help With Your Workers’ Comp Claim

Sometimes workers’ comp claims are straightforward, and workers’ receive their benefits with no issues. However, some workers’ comp claims are difficult and could benefit from the help of a qualified attorney.

At Jay Trucks, our workers’ comp lawyers in Grand Rapids have helped many injured workers. We have decades of experience and have recovered millions in compensation for injured victims throughout Michigan.

Contact our firm anytime, night or day, to get a free consultation and find out how we may be able to help. If you choose to hire our services, there is nothing for you to pay up front. We only get paid if we are successful in getting you the benefits that you need.

Experienced. Local. Lawyers. Call: 989-244-0356