Workers Comp denied my claim and my health insurance won’t pay medical bills, what do I do?
You were injured at work and as a result, you’ve needed medical care. Maybe you have a fracture, a burn, or recurring pain in your wrist. Whatever it is, you had to seek medical care to take care of it. To make matters worse, you come to discover that both workers comp and your health insurance are refusing to pay the bill. Talk about adding insult to injury!
Well – there’s good news. If the workers compensation insurance company has denied your claim or is denying payment of a specific medical bill, your health insurance must pay for the bill. This includes BlueCross BlueShield (BCBS), MVP, Cigna, Vermont Health Connect, Medicaid, and Medicare. You just need to make sure that your medical provider has billed your health insurance company, and that your health insurance company has a copy of the workers’ compensation denial.
Here are the steps we recommend in this situation:
If your whole workers’ comp claim has been denied:
- Send a copy of the Denial to your health insurance company.
- Then call your provider and make sure they send your bills to your health insurance company. Note that your medical provider cannot refuse to bill your health insurance company if the workers’ compensation carrier has denied payment.
If your workers comp claim has been accepted, but just one or two bills aren’t being paid:
- Call the medical provider and make sure the bill was sent to the workers’ compensation insurance carrier for payment. Ask for the date that it was sent. If you find that the medical provider did not send the bill to the workers’ compensation company, tell them to send it now.
- If you’re sure the bill was sent, ask if the provider received a written denial from the workers’ compensation insurance company. If they did, ask them to email, fax, or mail you a copy of the denial. (If workman’s comp did not officially deny the medical bill on the proper form (Department of Labor Form 2) within 30 days of receiving it, the carrier must pay the bill.)
- If workers comp has sent a written denial, make sure the provider then sent the bill to your health insurance company for payment.
- Send your health insurance company a copy of the Denial. You will need to get a copy of the workers’ compensation insurance company Denial and send it to your health insurance. If you do not have a copy of the Denial, you should be able to get it from the workers’ compensation insurance company, or from the medical provider, or by calling the Vermont Department of Labor at (802) 828-4000.
Once your health insurance sees a copy of the workers’ compensation insurance denial, they must pay the bill. If in the future, your claim gets accepted, your health insurance company will be refunded its payment of the bill(s); or if you settle your workers’ compensation claim you may have to pay back your health insurance some portion of the bills it paid.