Why Is It Difficult to Get Medical Care Reimbursed After a Workplace Injury in MA?

After experiencing a workplace injury in Massachusetts, it is often difficult to get reimbursed for your necessary medical care. Even though you typically have the option to select your own doctor, many issues with the Workers’ Compensation system can cause you to lose out on medical expenses that should have been covered.

When you suffer an injury at work, finding the right healthcare provider is just the beginning. It is possible that you will have to see a doctor who has been approved by your employer for your first visit. Unfortunately, due to problems within the Workers’ Compensation system, some doctors are declining to treat patients or not reimburse their insurance. Even if you have a right to medical care, certain healthcare providers might not agree to accept payment from Workers’ Compensation insurance.

Call the Law Office of John J. Sheehan at (617) 925-6407 for a free case review with our Boston workplace injury lawyers.

Why Is It Difficult to Get Medical Care After a Workplace Injury in Massachusetts?

Getting proper medical care and reimbursement can be challenging without legal support, especially in today’s climate, where some medical professionals might refuse Workers’ Compensation as payment. This is because doctors who accept Workers’ Compensation often receive lower compensation rates compared to Medicare, resulting in less payment for the treatment they provide. Unfortunately, this puts the injured worker in a difficult position as they seek necessary treatment.

Finding a doctor who will treat an injured worker can be challenging, as there are fewer providers available for Workers’ Compensation claims. Therefore, it is crucial to work with our Massachusetts workplace injury lawyers right away after experiencing a work-related injury. This search can result in the worker missing more time from work and potentially worsening their injuries. For instance, if surgery is needed but not performed soon after the injury, permanent damage can occur. Hiring an attorney to represent the worker can help overcome some of the barriers to receiving proper treatment.

It is possible that the healthcare provider is not the only obstacle to obtaining entitled benefits. If the employer is preventing the worker from filing a claim or doubting the legitimacy of the injury, seeking legal advice might be necessary. Employers generally prefer to pay insurance benefits rather than face a lawsuit to determine compensation in the case.

Can You Choose Your Own Doctor After Suffering a Workplace Injury in Massachusetts?

Receiving Workers’ Compensation benefits in Massachusetts can be difficult since the system is often ineffective and wasteful for those who are injured. Even if a worker is eligible for these benefits, it might be challenging to receive the necessary treatment under Massachusetts regulations. This will increase the likelihood of getting prompt and appropriate treatment for injuries without further harm.

If a worker has a Workers’ Compensation claim in Massachusetts, they are allowed to choose a medical provider of their choice. However, if the employer or their insurance company has a “Preferred Provider Agreement,” the initial appointment must be at one of the preferred facilities. After the first appointment, the injured worker can schedule appointments with their chosen physician. It is essential to follow this procedure to avoid jeopardizing the Workers’ Compensation claim and causing issues for many injured workers.

How Our Massachusetts Workplace Injury Lawyers Can Help Your Case

When submitting a Workers’ Compensation claim in Massachusetts, it will be beneficial to have the support of an attorney. Not only can we help prepare your claim, but we can also help ensure that you get the medical care you need. We will also fight for you if you are having trouble getting your medical care reimbursed. While not obligatory, having legal representation can aid you in maneuvering the process and addressing any complications that might emerge. Our team can offer assistance in a variety of ways, such as those outlined below:

File Your Workers’ Compensation Claim

If you have sought medical attention, we can assist you with navigating the process of filing your Workers’ Compensation claim. It is important to note that in Massachusetts, it is the responsibility of the claimant to file their claim, which might not be widely known. While your employer is required to inform their Workers’ Compensation insurance provider of your injuries, it is up to you to handle the rest, including being mindful of important deadlines for filing. This can be challenging for those who are unfamiliar with the claims process.

To prevent costly delays or the denial of your claim, it is crucial to provide all necessary supporting documents and ensure that there are no errors in your paperwork. Our team is available to help you review your case, identify any missing evidence, and guide you in obtaining it. By having well-organized and complete evidence, you can confidently submit your claim and increase the likelihood of its approval.

Appeal a Claim Denial

In the event that your Workers’ Compensation claim is not approved, it is mandatory for employers and insurance companies to provide a valid explanation for their decision. Our firm is available to assist you in challenging this decision. In the case of clerical errors causing the denial, we can gather the necessary paperwork or complete the filing forms correctly when resubmitting the claim.

Should your claim be rejected for legitimate reasons, you do have the option to appeal the decision. Please be aware that seeking legal guidance does not guarantee a favorable outcome. Your appeal will be initially reviewed by a Workers’ Compensation judge, with the possibility of further appeals to the Massachusetts state court. However, it is imperative to remember that if the underlying reasons for the denial are not addressed, the judge or court might uphold the rejection of your claim.

Determine Whether a Lawsuit is the Next Step

There are instances where Workers’ Compensation might not be an option for someone seeking compensation for a work-related injury. While this type of compensation typically prohibits lawsuits for such injuries, certain injuries might require a lawsuit in order to receive compensation. This is often the case for independent contractors, who are typically not covered under their employer’s insurance. Additionally, if a third party who is not liable to the employer caused the injuries, a lawsuit is usually necessary.

Sometimes, a lawsuit is necessary to start receiving medical treatment. Many doctors turn away injured workers, regardless of whether it is legal or not, making it necessary to file a lawsuit in order to compel medical providers to give treatment. Filing a lawsuit can also potentially lead to compensation that covers medical expenses. In some cases, medical care might be available while waiting for a settlement or trial award.

Our Massachusetts Workplace Injury Attorneys Can Help

For a free case evaluation with our Chelsea workers compensation attorneys, call the Law Office of John J. Sheehan today at (617) 925-6407.