Workplace accidents and injuries often leave workers in considerable pain. To get well, you need individualized medical attention from a licensed physician. Helpfully, Vermont requires that your employer’s workers’ compensation insurer cover all necessary and reasonable medical care. But what types of treatment is covered? Our Burlingtonworkers’ compensation attorneys look at some of the most important categories of medical care which you should not have to pay for.
Diagnostic Tests
Before you can receive treatment, your medical team needs to find out what’s wrong with you. Diagnostic tests are critical and can include:
- X-rays and other imaging tests (MRIs, CT scans, etc.)
- Bloodwork
- Biopsy
- Sleep studies
- Observational studies
Surgery
Some injuries or illnesses require surgery. You should not have to pay for surgical expenses. For example, some illnesses require surgery to remove tumors or even entire organs. Other patients need surgery to help with spinal column injuries, fractures, or chest wall injuries.
The workers’ compensation insurance company might not immediately approve surgery, instead preferring you try conservative treatment instead. For example, you might damage a disc between your vertebrae, so your doctor tries steroid injections and physical therapy before agreeing to operate on the disc.
Other Medical Procedures & Treatment
Not everyone needs surgery. Workers’ compensation should still cover any necessary and reasonable medical procedures:
- Casts (for setting broken bones)
- Spinal adjustment or manipulation
- Bracing
- Cortisone injections
- Chemotherapy or immunotherapy
- Antibiotics
Sometimes, doctors need to try out different treatments to find out which works best. That is reasonable, and the insurance company should cover treatment even if it ultimately wasn’t successful.
Doctor’s Visits
In addition to receiving treatment at the doctor’s office, you’ll probably have follow-up appointments to check in on how you are doing. If the doctor requires these visits, then you should not have to pay for them.
Rehabilitation & Physical Therapy
Many injuries require physical therapy to help an injured worker regain function. For example, you might have suffered a serious brain injury, which leaves you unsteady on your feet and unable to walk. Physical therapy could help regain balance and the ability to move your legs.
Serious brain injuries could also impact your ability to speak, which could require speech therapy. Other therapy includes occupational and behavioral therapy, depending on your injuries.
Prescription Medication
Medication can aid in recovery. Pain medication is common, but you might also have other drugs to fight infection, reduce swelling, manage anxiety, and treat depression. You should not have to pay for medication that is prescribed to treat your injury or illness.
Durable Medical Equipment
Injured workers often need equipment to help them recover, including:
- Crutches
- Wheelchairs
- Braces
You should not have to pay for any device which is reasonably necessary for your physical recovery.
Home & Vehicle Modification
A severely injured worker could require reasonable modification of their home to help them live with a permanent disability. For example, a spinal column injury could confine a worker to a wheelchair for the rest of their life. Home modification is often necessary to help them get into the house and move around.Vermont law specifically states that an employer “shall” provide reasonable modification if a disability limits a worker’s ability to live at home or perform daily tasks.
A disabled person might also qualify to have a vehicle modified, which will allow them to continue driving. Do not be surprised if an insurer tries to push back on proposed modifications, often because of the expense. You should contact an attorney if you are being denied this coverage.
Palliative Care
Even after you reach maximum medical improvement, you could still require palliative care. For example, someone who suffered a terrible back injury might have the bones heal but still feel pain. Your insurer should pay for this care even after you’ve fully recovered from the injury.
Some workers might require palliative care for the remainder of their lives. That’s fine. Worker’s compensation should continue to pay these expenses.
Transportation Expenses
Injured workers might also receive a mileage reimbursement to cover the costs of traveling to receive treatment. In a rural state like Vermont, you might need to travel a great distance to reach a specialist for treatment, so you could also potentially qualify for meals and lodging. You should hold onto receipts for any meals or hotel rooms, which the insurer will want to see.
Nursing Care
Skilled nursing care is sometimes necessary, especially with significant injuries. Vermont workers’ compensation will cover reasonable nursing care.
What is Not Covered by Workers’ Compensation?
Workers are often frustrated when their medical bills are not covered, but there are simple explanations behind the denials:
- Unnecessary care. For example, you might want massage therapy to help manage pain and sleep disruption. However, this type of treatment is typically not covered unless a licensed medical provider requests it for you.
- Cosmetic treatment. Medical procedures which are merely cosmetic are not covered. For example, teeth whitening services are not covered by workers’ compensation. But if your teeth were cracked by a facial injury, then you should seek compensation because cracked teeth could be a physical limitation.
- Unauthorized care. You might also have medical bills rejected if you did not meet with a doctor selected by your employer. Under Vermont law, your employer can pick your doctor for your initial appointment. You should consult an attorney to see if you can contest a denial.
The best way to ensure coverage is to meet with a licensed medical provider and call our firm if you have questions. Many workers find that receiving medical care is a seamless experience; others feel as if they are hitting their head against a brick wall to get approved for services.
Contact Larson & Gallivan Today
Our Burlington workers’ compensation lawyers are eager to help anyone injured on the job. These benefits are a critical lifeline for injured workers and their families, but some insurance companies unfairly deny claims. Let us review your options. We might help gather additional evidence in support of your claim or even file an appeal.
