Pennsylvania workers’ compensation and the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) was enacted in 2010 and, on January 1, 2014, major provisions of the Act will come into play. How the ACA - also known as Obamacare - will affect individuals in Pennsylvania remains to be seen, but below are some important and helpful changes that should provide assistance to people who suffer injuries in the workplace.

Denied claims

Medical treatment is most effective when provided immediately following an injury or illness. Every year, according to the U.S. Department of Labor, more than 4 million workers across the nation sustain serious work-related injuries or illnesses, and hundreds of thousands of those injured workers are in Pennsylvania. Unfortunately, employers and their insurance carriers wrongfully deny many workers' claims for benefits and medical care.

Common reasons for denying a workers' compensation claim may include the following:

  • The worker is not an employee
  • The injury is not work-related
  • The doctor's records are insufficient to establish an injury claim
  • Medical or administrations records are lost or incomplete

Thankfully, under the ACA, most employees will have some type of health insurance coverage next year. This is crucial for one very important reason: A denied or delayed approval of a workers' compensation claim can keep an employee from receiving medical care that is vital for his or her recovery. Due to ACA requirements, injured workers will be entitled to medical treatment and benefits while they await approval of their claims.

Pre-existing conditions

One significant benefit of the ACA is that individuals should no longer have difficulty obtaining health coverage if they have a pre-existing condition or chronic illness. Starting January 1, 2014, insurance companies must not:

  • Deny medical coverage based on a pre-existing condition
  • Charge higher premiums because of a pre-existing condition
  • Refuse treatment based on a pre-existing condition

According to the U.S. Department of Health and Human Services, nearly 5.5 million non-elderly people in Pennsylvania suffer from pre-existing medical conditions. When an individual incurs an injury at work, workers' compensation benefits are often wrongfully denied based his or her pre-existing condition and, hopefully, such denials will be reduced.

A lawyer can help

The interplay between health care benefits and workers' compensation benefits may become complicated as provisions of the ACA come into play. If you suffer an injury in the workplace, consult an experienced injury lawyer. An attorney knowledgeable about personal injury, disability and workers' compensation claims will be able to help you obtain compensation and medical care to which you are entitled.

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