Generally, for workplace injuries an employer is liable for all medical bills reasonable, necessary and causally related to the work injury. Once an employer accepts liability for a work-related injury it can’t stop payment of medical bills without an agreement or a Workers’ Compensation Judges’ order. What is reasonable and necessary may be challenged by an employer by filing a Utilization Review. In addition, an employer may refuse to pay medical bills based on a lack of causation. Sounds simple but these rules raise a number of issues.
What is the accepted work injury? Generally the insurance carrier has 21 days to accept or reject the injury. They are to list on the appropriate Bureau forms what they are accepting. They can issue a Notice of Compensation Payable accepting the injury, a Medical only Notice of Compensation Payable, a Notice of Temporary compensation Payable (which can be withdrawn within 90 days), or a Notice of Compensation Denial (accepting medical only), or an Agreement for Compensation. Each one of these forms has significant legal importance and meaning.
Frequently litigated is what constitutes the accepted work injury. One reason is that the term injury is often used to encompass three different things, the event causing the injury, the diagnosis, and the body part injured.
Often the Bureau documents listing the injury often need to be changed because there is a time limit on the insurance company as to when they must issue them. The Notice of Compensation Payable must be issued within 21 days and sometimes the true diagnosis hasn’t been discovered yet (think low back sprain later determined to be a herniated disc) or an injured worker continues to treat and additional medical problems may arise And don’t be fooled, the law is clear that payment of medical bills is not an acceptance of a work related injury.
When dealing with acceptance of workplace injuries it is very important that the correct injury is accepted or that the documents have the correct description of the injury otherwise it can seriously effect payment of loss wage benefits or medical bills. If you have questions about workers’ compensation, or if you have been injured at work and are fearing the inevitable piles of medical bills you will soon be receiving, call Pittsburgh workers’ compensation attorney Mitch Dugan today for a free consultation at 888-99-DUGAN.