2024 What Happens to Medical Bills When Workers’ Compensation Is Denied in California?

Workers’ comp insurance is required to be held by California employers in to protect employees in the event of a workplace-related accident that leads to a disability. This insurance is no-fault, meaning the employee can receive benefits regardless of whether they were liable for the injury-causing accident or not. Among injured workers who have had their claims denied, a common question is, “What happens to medical bills when workers’ compensation is denied in California?”

By understanding the options to get medical bill coverage for work-related injuries in California after a rejected claim, injured workers can protect themselves from serious negative financial consequences, such as taking out large amounts of debt or filing bankruptcy. Furthermore, by understanding the potential reasons why their claim might have been denied, injured workers can appeal their case decision and optimize their chances of winning their claim after appealing.

How to Get Medical Bills Covered After a California Workers’ Comp Claim Rejection

If your workers’ compensation claim has recently been denied, you are likely wondering how you will cover past and future medical expenses associated with your work-related injury, including hospital bills, physical rehabilitation, surgical expenses, assistive devices, and more. Fortunately, an experienced workers’ compensation lawyer can help you explore the following options for covering your medical bills, including:

• Appealing the Workers’ Comp Claim Denial. If your workers’ comp claim has been denied, it’s critical to initiate the appeals process as soon as possible, as it is typically not possible to appeal more than three years after the decision dates. A workers’ comp lawyer can help you through the process of appealing your decision, which involves filing an Application for Adjudication of Claim and attending a judge hearing.
• Group Health Insurance. If you have group health insurance through your employer or the employer of a family member, it could be possible to use this coverage to finance the medical treatment required for your work-related injury or illness. Before pursuing this payment option, it’s critical to be aware of the extent of the coverage and potential out-of-pocket costs.
• Medicaid. Medicaid is a state and federal program that gives coverage to families and individuals with low-income backgrounds. If you are eligible to receive Medicaid, you may be able to enroll in the program and leverage such insurance to cover medical expenses, which could also cover your work-related injury or illness.
• Medicare. Medicare is a federally funded health insurance program for individuals who are 65 and older, but it can also cover some people who are younger than 65 and have physical or mental disabilities. Depending on your eligibility for the program and the details of your case, you may be able to use it to cover your work-related injury treatment.

It is critical to understand your options for covering the medical treatment for your work-related injuries or conditions. By considering factors such as coverage limits, out-of-pocket expenses, and eligibility criteria, you can decide which payment option is optimal for you. Additionally, an experienced and compassionate workers’ compensation lawyer can help you understand your options for appealing your claims decision and navigating you through the process.

FAQs

Q: Is There a Time Limit for Medical Billing in California?

A: Yes, time limits exist for medical billing in California. Medical providers typically have a year from the date that they provided their services to upload or submit bills for workers’ compensation claims. It’s important to note, however, that there could be certain exceptions, which vary on a case-by-case basis. Overall, it is crucial that medical providers submit their bills as swiftly as possible in order to comply with regulations for workers’ compensation.

Q: Can I Lose My Health Insurance While on Workers’ Comp in CA?

A: If you are a California worker who was injured on the job and are receiving workers’ compensation benefits, you could be eligible to keep receiving your health insurance coverage through your employer’s group health plan. However, you will need to continue to pay the required premiums.

If a worker is fired from employment and their employer’s health insurance plan is not continued as a result, they can lose their access to health insurance coverage. In cases like this, workers may be able to access coverage through COBRA or other means.

Q: Do All Workers’ Comp Cases End in a Settlement in California?

A: Not every workers’ compensation claim leads to a settlement in the state of California, even though they are a common outcome for a lot of workers’ compensation cases. This is especially true for cases that include permanent disability. However, some cases end up being resolved through other means than a settlement, such as through litigation.

In order to understand whether your workers’ comp case has a chance of ending in an optimal settlement, it’s important to work with an experienced workers’ compensation attorney.

Q: What Happens if I Don’t Have Workers Comp Insurance in California?

A: If your employer does not have workers’ compensation in California, then they could be breaking the law. Employers are required to have workers’ compensation insurance for their employees in case they are injured on the job and, therefore, can be subject to legal penalties and additional consequences if they do not have adequate coverage.

If you have been injured on the job and your employer doesn’t have coverage, you should talk to a workers’ compensation lawyer about your options to pursue compensation.

Explore Your Options for Paying Workplace Injury Medical Bills

If your workers’ compensation claim has been recently denied, then you are likely wondering how you will cover the mounting pile of medical bills associated with your work-related injury or condition. Such situations can be frightening, forcing individuals to take out large amounts of debt to pay off their medical bills.

Fortunately, an experienced and compassionate workers’ compensation lawyer from Canlas Law Group can help you explore your options for getting your medical bills covered, from considering group health insurance to appealing the decision on your workers’ comp case. Contact a lawyer from our employment law team to get started.