Can I get reimbursed for travel to medical appointments?
Yes. Under Workers Compensation Rule 4, when an injured worker is required to travel for medical treatment, medical exams, IMEs, and/or vocation rehabilitation related appointments, the injured worker is entitled to reimbursement for mileage, meals, and overnight accommodation. Current mileage reimbursement rates are available here.
You must provide reasonable documentation to the insurance company to receive reimbursement. You can use this form from the Department of Labor for mileage. For meals you should keep and submit receipts. The insurance company is required to pay the reimbursement within 21 days of receiving the written request. Make copies of everything you submit to the insurance company to make sure your reimbursement is paid in a timely manner.
How do I know whether my employer filed my claim?
Whenever a person reports that they were injured at work, an employer is supposed to file a First Report of Injury (also known as a Form 1) with the Department of Labor, regardless of how serious the injury was and regardless of whether the injury is disputed. The filing of the First Report of Injury does not mean that the employer is liable. Generally, the First Report of Injury is submitted by the employer’s workers compensation insurance company.
If you become hurt at work, you should report said incident to Human Resources or your supervisor as soon as possible. Once you report your injury and the employer files the report with the Department of Labor and their insurance company, you, as the injured worker, should receive a package of information from the insurance company.
If you believe that your employer has not reported your injury to the Department of Labor you can call and ask. The phone number to the Department of Labor is 802.828.2286. If your employer did not file the Form 1, then you, as the injured worker, must file a Form 5 Employee Notice of Injury with the Department. Here is more information from the Department of Labor’s website.
What is an IME? Do I have to go to it?
An Independent Medical Examination (IME) is a medical exam set up the insurance company to evaluate your medical situation. An IME may be scheduled for a number of reasons, including to determine whether your injury is related to work, whether you have reached a medical end point, whether a requested medical procedure or treatment is reasonably necessary and related to a work injury, and to determine your impairment rating.
You must always attend an IME unless you have received permission from the insurance company or the Department of Labor to not attend. You can request the exam be postponed or re-scheduled if:
(1) you are not given notice in writing at least seven days prior to the appointment;
(2) the location is more than two hours drive away from your house, or
(3) you cannot make the appointment due to things like illness, bad weather, previously scheduled medical or another appointment, work schedule, or a medical or other emergency situation.
If you cannot attend an IME as scheduled, you should contact the insurance adjuster as soon as possible and work with them to reschedule the appointment. If you miss the IME without giving notice to the insurance company, they can stop your benefits.
Can I pick my own doctor?
Yes, you have the right to choose your own doctor for treatment. Your employer can pick a doctor for your first medical visit. However, after that visit, you may pick your own doctor as long as you provide notice to the insurance company that you are changing doctors by filing a Form 8. You also have the right to change doctors at any time during your treatment (after the initial appointment with the doctor specified by your employer), and to get a second opinion for another doctor.
What is an Informal Conference?
An Informal Conference is the first step of the dispute resolution process administered by the Department of Labor. For more information regarding Informal Conferences click on the link above.
How long does the insurance company have to accept or deny a claim?
21 days, but they can request an extension. If you do not hear whether your claim has been accepted or denied within 21 days, you should contact the Department of Labor.
Am I getting the benefits I am entitled to?
It depends. There are four types of workers compensation benefits: Medical Benefits, Temporary Benefits, Permanent Benefits, and Vocational Rehabilitation Benefits. Depending on the facts of your case you may be entitled to all or some of the listed benefits. For more information on any one of these benefits, view [link to internal pages]. If you are unsure whether you are receiving certain benefits call me and we can figure it out together.
Why aren’t they paying my medical bills?
Sometimes the reason a bill has not been paid is because the medical provider did not send it to the workers comp insurance company, or it sent the wrong forms, or sent it to the wrong address. Your first step should be to call the medical provider and make sure they billed workers comp.
The insurance company can refuse to pay medical bills only in the following circumstances:
(1) it has already denied your workers compensation claim; or
(2) it files a written denial with the Department of Labor.
The workers compensation insurance company must pay all medical bills that are “necessary and reasonable” and “related to the work injury.” If it denies the bills for a legitimate reason, it must file a denial with the Department of Labor and send a copy to you and the medical provider.
The workmans comp insurance company cannot refuse to pay for a medical bill simply because you are at “medical end result” or “maximum medical improvement.” It must continue to pay all medical bills for the rest of your life (as long as they are related to the injury and are reasonable and necessary). After you reach medical end point, the insurance company must continue to pay for “palliative care,” which is medical treatment which helps you remain functional and decreases pain. Examples of palliative care are medications, chiropractic care, acupuncture, physical therapy, massage, etc.