Using Workers Comp for Health Coverage
Using your work comp coverage for a work-related injury or illness should be a straightforward process, especially if your medical services are clearly related to an incident or condition at your work. Larger employers' Human Resources departments should have defined procedures on how to use the insurance, and small employers should at least be able to refer you to the administrative firm or insurer who handles their coverage.
Here are a few things to remember when you need to seek medical care for a work related injury or illness.
- Notify your employer immediately. If an injury occurs at work, the employer needs to be notified immediately. Not only is it responsible to ensure they are in-the-know regarding the situation, but they can often point you in the right direction regarding accessing the care.
- Ensure you are aware of any health network requirements. In some states, employers can access workers comp insurance through entitles that resemble managed care plans. They may have requirements that dictate you see specific providers who are different than your regular health plan network or your preferred physician. In emergency cases, when you don't have the time to research this information prior to getting medical attention, these network requirements would likely exist for the follow-on care.
- Cooperate with paperwork and audits. A workers comp carrier may ask you to fill out paperwork that has a different look and feel than your typical insurance forms. Be sure to be on the lookout for this documentation and be responsive to them. Additionally, they may ask that you see an independent physician or nurse to evaluate your medical condition. This is all part of the process of subrogation - helping your primary insurer and workers comp carrier determine who is responsible for the payment of care.
- If your employee is not cooperating with the submission of a legitimate workers comp claim, contact your state Workers Compensation Commissioner's office. Names may vary slightly in different states, but every state has an agency that oversees workers comp.
With prompt action, thorough communication, and the ability to follow procedures, seeking medical care resulting from work injuries and illnesses can be a smooth process.