What Happens to Medical Bills if a Workers’ Compensation Claim Is Denied?

When you’re hurt on the job in North Carolina, you naturally turn to workers’ compensation to help you with your medical bills. Depending on the nature of your injury, the cost of care, medication, surgeries, and other expenses could be astounding.

North Carolina law is written so that you should not have to ask, “Does workers’ comp pay medical bills?” It does, if the insurance carrier accepts your claim – though they will choose the care providers and which care they pay for. But who pays for it all if the insurance carrier denies your claim? What happens when workers’ comp refuses to pay?

If Your Workers’ Compensation Claim Is Denied, You May Be Responsible for Your Medical Bills

That’s right. All costs of your medical care could fall to you if they deny your workers’ comp claim. That alone is reason enough for many injured workers to seek the help of an attorney. Even if you hire an attorney, you still need care while you fight your denial for benefits.

How Can I Get Medical Care if My Workers’ Compensation Claim Is Denied?

You’re injured, and you need medical care to get better. Delaying or skipping care could have dire long-term health consequences. Not only that, if you’re contesting a denied claim, a record of care can help.

It is helpful for a workers’ compensation claim to have a record of medical care. Even if your case is accepted, an insurance carrier may stop coverage if you’re not following your doctor’s recommendations. You never know when they’re watching.

A denied claim doesn’t mean you should skip care. Here are a few solutions that injured workers can try if workers’ comp is not paying medical bills.

Your Health Insurance Can Pay Medical Bills for Your On-the-Job Injury, But…

If you have health insurance, you may be able to use it to get the care you need as you fight your denial. This is often not the magic bullet some people think – almost every health insurance plan has a deductible, and many plans have high deductibles before their benefits kick in. Additionally, some health insurance policies may try to recoup any medical expenses paid on your behalf that result from your workers’ compensation injury.

That could strain finances, especially with you unable to work and earn, but it might be a reasonable option. If your workers’ comp denial is ultimately reversed, an attorney can help you seek to recover your out-of-pocket expenses.

What if I Am Fired While My Claim Is in Process?

Most worker’s comp attorneys would be highly suspicious of a firing while a workers’ compensation claim is pending. It is relevant because, along with your firing, your employment benefits could be affected. If you believe you were fired as a result of a work-related injury, contact an attorney immediately.

Medicaid May Be an Option for Some Workers

If you’re unable to work and earn a wage, and your earnings/assets are below a certain threshold, you may qualify for Medicaid to assist with your medical care. However, it is important to note that Medicaid may require you to repay them for related medical expenses out of any settlement or award. For that reason, it’s important to consult with an experienced workers’ compensation attorney before considering this option.

Don’t Hesitate to Call for Backup

You want someone to have your back. You may love your boss or employer, but they may not be able to help you – even if they want to. The insurance carrier has their own best interests in mind. An experienced workers’ compensation attorney fights for your best interests and more.

We can help you stand up to the people who you believe should be paying those bills and fight for everything you may be entitled to under the law.

If you were injured on the job, and your workers’ compensation claim was denied contact us right now.

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About the Author

Ryan Bliss is a workers’ compensation attorney in North Carolina and co-leader of the Workers’ Compensation Department at the Law Offices of James Scott Farrin. Ryan is one of fewer than 200 North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law.a He was named a “Rising Star”b by Super Lawyers Magazine in 2018 and wrote an article called “Workers’ Compensation for the Undocumented Worker” for Trial Briefs Magazine in January 2018.

aNumbers provided by NC State Bar as of 2/21.

bFor more information regarding standards of inclusion, please visit www.superlawyers.com.

five star review badge Former Workers’ Compensation Client, Online Google Review
I want to thank everybody who worked on my case at James Scott Farrin.

I want [to] thank everybody [who] worked on my case at James Scott Farrin. They did a very professional and great job. I would recommend them to anybody that was ever looking for a lawyer, and I definitely would use them again. 1

For legal reasons and client confidentiality, reviews have been slightly edited to remove identifying information and correct typos.