What Medical Expenses Are Covered Under Workers’ Compensation?

What Medical Expenses Are Covered Under Workers’ Compensation?

What medical expenses are covered under workers’ compensation? Common medical expenses covered under workers’ compensation in Chicago, Illinois include emergency medical services, doctor’s visits, surgical interventions, prescription medications, hospital stays, and physical therapy and rehabilitation. Medical cost coverage enables workers to get necessary medical treatment after getting injured or ill on the job.

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Obtaining enough workers’ comp benefits to pay the full extent of your medical expenses and other losses is an arduous process. Fortunately, workers’ compensation lawyers know what is covered by workers’ compensation and can build a strong claim to maximize your benefits.

Call Martay Law Office at 312-374-6403 for assistance filing a workers’ comp claim and recovering a decent compensation. Consultations are free.

Medical Expenses Covered by Workers’ Compensation

Workers’ compensation benefits cover any medical expenses arising out of a workplace injury. These expenses typically include:

Emergency Medical Treatment

A workplace accident may leave you with serious injuries that require urgent medical procedures. Workers’ comp will cover the cost of such procedures.

Doctor’s Visits and Consultations With Medical Specialists

Your recovery may involve regular medical examinations by your treating doctor, follow-up appointments, and consultations with medical specialists. Your medical benefits under workers’ comp will pay for those expenses.

Diagnostic Tests

Your doctor may require you to take blood tests and imaging tests like X-rays and MRI(s). These tests help the doctor determine the nature and severity of your injury or illness. They also enable the doctor to keep track of your recovery journey.

Prescription Medications

You may require prescription medications to alleviate pain, prevent infection, and speed up recovery. The cost of such medications is part of the medical expense coverage.

Surgical Interventions and Hospital Stays

Surgeries may be necessary to treat work-related injuries like severe bone fractures or breaks. You may need to stay in the hospital until you are stable enough to get discharged. You will incur admission charges, room fees, and medical procedure costs. All these expenses are usually included in medical coverage.

Physical Therapy and Rehabilitation

Work-related injuries can affect your ability to do your job duties and even result in long-term disability. Physical therapy and rehabilitation can help you regain your self-confidence and functionality for a safe and sustainable return to work. Workers’ comp will pay for physical therapy and rehabilitation provided it is declared medically necessary for your recovery.

Necessary Medical Equipment

Workers’ comp insurance will pay for your medical equipment. Medical equipment constitutes medical supplies like bedpans, wipes, and bandages, and durable medical equipment (DME) like crutches, orthopedic pillows, and wheelchairs. Medical benefits may also pay for modifications to your vehicle or home if your work injuries leave you with a permanent disability.

Factors That Could Impact Coverage

Numerous factors impact coverage amounts under a workers’ comp claim. These include:

Type of Work Injury Suffered

A serious work injury attracts a higher value than a less serious one. Your claim will be worth more if you suffer serious injuries that prevent you from working. This is because work injuries that keep you from holding your previous role are more costly.

Future Medical Treatment Requirements

Some injuries sustained at work require ongoing or future medical care. Such injuries have a higher value than those that need one-time treatment. Injuries that will require surgical interventions in the future will attract higher compensation.

You may get higher medical expense coverage if your injuries need ongoing medication, physical therapy, and rehabilitation. Your treating doctor can assess your injuries to develop an appropriate treatment plan for the future.

Your Doctor’s Credibility

Medical expert testimony is the cornerstone of a successful workers’ compensation claim. A doctor within your employer’s network of medical providers is less likely to support your claim. That’s why it pays to go to your own doctor. Your doctor knows your medical history and can determine when you are ready to return to work accurately and can testify in your favor.

You stand a better chance of obtaining decent compensation if your doctor is credible and has a history of handling work-related injuries.

The Likelihood of Future Medical Issues

Your claim value will increase if your injuries increase your risk of developing medical problems in the future. For instance, back injuries may make you susceptible to hip and knee injuries. Your workers’ comp benefits must account for the cost of treating such injuries in the future.

Your Injury Is Linked to a Previous Injury or Pre-existing Medical Problem

Your employer or workers’ comp insurer may deny your claim if your work injury is related to a previous injury or pre-existing medical issue. The employer or insurer may try to argue that your injury did not directly stem from work but a previous condition or injury.

Whether You Hire a Lawyer

Not hiring a lawyer is one of the mistakes to avoid when filing a workers’ comp claim. You may get a lower settlement or your claim denied altogether if you pursue your workers’ comp claim alone.

A lawyer with a history of resolving workers’ compensation can improve your chances of getting a reasonable settlement. Your lawyer will ensure you have filed all the paperwork correctly and complied with all the rules and regulations related to the workers’ comp claim. The lawyer will represent your best interests during negotiations with the insurer or workers’ comp hearing.

Other Benefits for Injured Workers in Illinois

Aside from medical benefits, injured workers in Illinois are entitled to disability, vocational rehabilitation, and death benefits under worker’s comp.

Disability Benefits

Workers’ comp may offer you disability benefits if your work injury hurts your ability to work. These benefits fall into the following four categories:

Temporary Partial Disability (TPD) Benefits

You may be eligible to receive TPD benefits if your job-related injury has affected your ability to work, but has not left you totally disabled. You may, for instance, have sustained an injury that allows you to perform your pre-injury job duties on a part-time basis. Alternatively, you may have the capacity to do job duties in another position where your earnings will be lower than your pre-injury job. TPD benefits are usually 66.6% of the difference between your pre-injury wages and current wages.

Temporary Total Disability (TTD) Benefits

You may receive TTD benefits if you must spend time away from work to seek treatment and recover from an on-the-job injury. You will continue receiving these benefits until you have recovered enough to return to work.

TTD benefits are 66.6% of your average weekly wage. You qualify for these benefits if your injuries keep you from working for three days. The first three working days will be included in the compensation if you miss work for 14 consecutive days. TPD benefits will stop once you have completed your treatment and returned to work.

Permanent Partial Disability (PPD) Benefits

You might qualify for PPD benefits if you have lost parts of your body or lost the ability to perform crucial job duties because of your injuries, and will not recover this functionality.

Permanent Total Disability (PTD) Benefits

You may collect PTD benefits if you sustain a disabling work injury that keeps you from returning to employment for the rest of your life. Your doctor will assess if you have a permanent impairment or disability once you attain maximum medical improvement (MMI).

These benefits usually cover 66.6 % (or two-thirds) of your pre-injury average weekly wages. You will receive them for the rest of your life. Injured workers sometimes receive PTD benefits in lump sums to cover their future payments.

Vocational Rehabilitation Benefits

Your job-related injury may keep you from working in the same capacity as you did before, or from returning to the same workplace altogether. In this case, you will be entitled to vocational rehabilitation benefits.

These benefits will pay for rehabilitative training to help you regain your skills to work in your pre-injury position. If you cannot return to your previous job, they will cover the cost of training for another job.

Death Benefits for Eligible Dependents

Work injuries may result in fatalities. In such cases, the deceased worker’s loved ones are eligible to receive death benefits under workers’ compensation. These benefits cover the medical cost incurred by the worker before death, two-thirds of the worker’s earnings before death, and funeral and burial costs.

Workers’ compensation lawyers at Martay Law Office resolve workers’ comp cases in Chicago, Illinois. Contact us for legal help in pursuing workers’ comp benefits.

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association