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Medical Expenses Under Workers Compensation

Wisconsin Workers Compensation Ensures You the Doctor of Your Choice

Medical expenses make up over 60% of all workers compensation benefits paid in Wisconsin. Workers compensation law requires the insurance carrier (or self-insured employer) pay for all treatment that may be reasonably required to “cure and relieve” the injured worker from the effects of a work injury. Typical kinds of treatment include office visits, diagnostic tests, medication, physical and occupational therapy, injections, surgery, and pain management. The injured worker is also entitled to reimbursement for transportation costs, usually mileage and parking. Mileage is reimbursed at 51 cents per mile (2014).

Choice of Treating Physician

The first medical expense issue that arises in workers compensation cases is the choice of a treating physician. Wisconsin is one of only a few states that give the injured worker the nearly unlimited ability to choose a treating doctor. Often, however, employers and their insurers direct injured workers to a particular clinic. You do not have to go where the employer wants you to go. The choice is yours. In fact, the insurance carrier is responsible for medical expenses from two physicians. All doctors practicing in the same clinic count as one doctor. Any doctor seen upon a referral by a prior doctor does not count as an additional choice.

Out of State Treatment

Some work injuries result in medical treatment in another state or country. Common situations are those where the employee lives near the Wisconsin border or requires highly specialized treatment, like at the Mayo Clinic. In order for medical treatment at out-of-state healthcare providers to be covered, the injured worker needs a referral from a physician practicing in Wisconsin.

Post Healing Plateau Expenses

Another common issue in workers compensation cases is whether the insurance carrier must continue to pay for treatment after the treating physician has declared a healing plateau has occurred. Once receiving notice of a healing plateau, most insurance carriers inform the injured worker it will no longer pay for medical treatment related to the injury. The law, however, obligates the insurer to pay for treatment to prevent further deterioration or maintain the existing status of the worker’s condition whether or not the healing plateau has been reached.

If you are not getting medical treatment covered by the workers compensation carrier that you feel should be covered, please case evaluation with one our experienced workers compensation attorneys at Hawks Quindel to make sure you are receiving all the benefits you are entitled to under the law.