Workers’ Compensation Insurance: What Medical Expenses Are Covered?

Medical Expenses

If you are looking at workers’ compensation coverage for your employees, you are probably interested in medical expense coverage. While it is true that workers’ compensation covers medical expenses for your employees who experience covered work-related injuries, it is not blanket coverage for all medical expenses. Understanding what type of medical expenses are covered can help you decide if workers’ compensation is right for your business. In fact, even in states that require workers’ compensation, some employers may also want additional protections for their workers.

What are medical expenses?

Generally speaking, medical expenses include costs for medical treatment that is necessary because of a work-related injury of illness. They include emergency care, doctors’ visits, imaging, blood tests, hospital stays, and rehabilitation. However, for an expense to be covered, it must be reasonably related to the injury.

Each state has its own rules about what type of medical expenses are covered under workers’ compensation. It is always better to check with the insurance company directly to see if an expense is covered than to assume that it is not. Your company’s HR professionals may also be able to provide guidance about state laws regarding coverage.

Diagnostic Tests

One of the trickier areas of coverage is diagnostic tests. Workers’ compensation coverage handles diagnostic testing. However, the testing has to be related to the injury. An employee with a broken leg means that workers’ compensation will cover the cost of the x-ray. However, it may not cover the costs of other diagnostic tests ordered that do not relate directly to the injury. If the recommended tests are normal for that type of injury or required because of special circumstances, they should be covered.

Alternative Treatments

Generally, workers’ compensation coverage is based in Western medicine. That means it may not cover alternative therapies. Alternative therapies may include things like acupuncture and even some types of chiropractic care. If you want employees to be able to pursue alternative treatments, you may want to consider adding that type of coverage to their standard healthcare policies.

Number of Treatments

Workers’ compensation insurance is meant to help an employee recover from an illness or injury. The coverage is, by nature, limited. Workers’ compensation will generally cover a minimum number of treatments. Your employee may be able to get additional treatments covered if they can show that the treatments are continuing to provide benefits. It is not unusual for employers to require employees to get reviews from employer-linked doctors before authorizing extended treatments.

Categorized in: Blog, Business Insurance, Workers Compensation Insurance