If you’ve been hurt at work, your focus should be on getting better. But what happens if the best treatment isn’t in Wisconsin or you move out of state while your worker’s compensation claim is still open? This is where things can get complicated.
Many injured workers assume they can treat wherever they want. Others worry they’ll lose benefits entirely if they leave the state. The truth is somewhere in the middle
Out-of-State Treatment is not Automatically Compensable
Under Wisconsin law, the worker’s compensation insurance carrier for your claim must pay for reasonable and necessary medical treatment related to your work injury. You also have significant control over your care. In most cases, you can choose your own doctor and even get a second opinion. However, your initial choices of doctors must generally be licensed and practicing in Wisconsin. Wisconsin Statute § 102.42(2)(a) notes that an injured employee has their choice of a provider “licensed to practice and practicing in this state” for their treatment. There are some situations in which out-of-state treatment will be covered.
When Out-of-State Treatment is Covered
Consent
Wisconsin Statute § 102.42(2)(a) also indicates, “By mutual agreement, the employee may have the choice of any qualified practitioner not licensed in this state. Accordingly, if the worker’s compensation carrier agrees that you can treat outside of Wisconsin, the carrier cannot deny coverage for your treatment on the basis that it takes place out of state.
Referral
Out-of-state treatment that is referred by a Wisconsin provider is compensable, even without the explicit consent of the worker’s compensation carrier. UFE, Inc., v. LIRC, 201 Wis. 2d 274, 285-86 (1996). Getting a referral from a provider in Wisconsin is generally the easiest way to ensure that your out-of-state treatment is covered. It is important that this referral happens before you begin treatment in the new state. For example, in one case, an injured worker was awarded out-of-state medical expenses, but only after he had obtained a referral and any treatment that he had prior to that referral was not compensable. Rivera v. Stoughton Trailers, Claim No. 2005-040969 (LIRC Feb. 28, 2008).
What if you reside outside of Wisconsin but your injury is covered under Wisconsin worker’s compensation law? The statute does not make a specific exception for this so it would still be recommended to get a referral from a Wisconsin provider or confirm that the worker’s compensation carrier consents to your treatment out of state.
Emergency Treatment
If you are out of state and you need urgent treatment, these expenses may be covered without the need to get a referral or consent from the insurance company. Brad Miller v. Roberts Roofing & Siding, WC Claim No. 1999-03972 (LIRC July 9, 2007).
Tips for Relocation
Moving does not automatically end your worker’s compensation benefits, including medical benefits, but it can make your case more complicated. If you are relocating out of state and want to ensure that your medical expenses continue to be covered, it is important to talk with your doctor and get a referral to a new provider. If your worker’s compensation claim remains open and accepted, speak with your claims representative and have them confirm in writing that they consent to you getting out of state treatment.
Need Help Navigating Your Claim?
Worker’s compensation rules around medical treatment can be surprisingly technical, especially when multiple states are involved. If you’re dealing with a claim and unsure about your rights, contact one of our experienced attorneys today to discuss your case.