Injured employees typically know that workers’ compensation can cover their medical costs. If they suffer a major laceration due to a slip of the wrist while handling a tool or break a bone because they fall while working, they know that workers’ compensation can cover their immediate medical expenses.
The health care coverage available through workers’ compensation is valuable in part because there are no patient responsibility costs imposed. Employees don’t have to pay a deductible or cover coinsurance when they require medical care. Of course, there are limits to what workers’ compensation covers.
Not everyone responds to treatment with a full recovery. In some cases, people have lingering or permanent symptoms that could persist for life. They may require long-term care, including regular physical therapy or prescription drug regimens, to manage pain and other symptoms.
Does workers’ compensation help cover long-term care costs related to work injuries or work-acquired illnesses?
Employees can receive long-term benefits
Eligibility for medical coverage through workers’ compensation depends on a few factors. The first is the presence of a verifiable medical condition caused by employment. The next is how well the patient responds to treatment. Medical benefits typically end when a doctor asserts that a patient has made a full recovery.
Workers’ compensation may also limit the medical benefits provided if the employee achieves maximum medical improvement (MMI). If a condition is not likely to fully resolve with care, then the injured professional may not be eligible for treatment coverage anymore. Workers’ compensation does not pay for care that is unlikely to yield any benefits for the worker.
However, ongoing symptom management, possibly for the rest of a worker’s life, could be eligible for worker’s compensation coverage. Employees who have achieved MMI but who still have symptoms can use workers’ compensation to pay for their ongoing costs. Workers’ compensation can also cover treatment expenses when a worker previously declared healed experiences a recurrence of their prior symptoms.
Reviewing medical issues and treatment records with a skilled legal team can help an employee optimize their workers’ compensation benefits. Those who understand the benefits available to them can pursue the coverage that they deserve for a work-acquired medical issue.