Medical Expenses

People generally think of  Maine workers’ comp. in terms of its cash benefits (indemnity), but someone with a work-related injury is entitled to treatment at the employer’s expense. (Most of the time it’s actually an insurer that pays on behalf of the insured employer, but that’s beside the point.) Depending on the nature of the injury and its symptoms, treatment may consist of medication, surgery, emergency services, physical therapy, a medical device, psychological counseling, or a hearing aid; this is by no means an exhaustive list. I’m glossing over the lawyerly details here, admittedly, but this is the essence of the legal right.

You may or may not be surprised to learn that sometimes the medical-cost component of a workers’ comp. claim becomes more expensive than the cash-compensation component. For example, I once had a client who missed a few weeks of work for surgery, which didn’t result in much compensation for lost wages, but his medical expenses totaled something in the range of $100,000. This component can also become highly contentious, as is evident from several Appellate Division decisions that hinged on whether certain expenditures were “reasonable and proper” for the work-related injury at issue. When surgery-related costs for a fairly routine procedure easily total over $10,000 and patented prescription drugs can cost $100 for a refill, it is not surprising when insurance companies push back. Most of these payments are governed by a fee schedule, but that doesn’t mean an injured employee can be cut off from further services after his or her bills reach a maximum amount. (The costs would be much lower if the United States had a single-payer health care system, but that’s a topic for another day.)

If you’re an injured worker with a stack of medical bills that the workers’ comp. insurer refuses to cover, you have the right to petition for payment of those bills. If you do petition, you have the right to the assistance of an attorney.