In most cases, workers’ compensation will cover the cost of a necessary emergency room (ER) visit (and all other required medical treatment) after an on-the-job injury.
If your employer’s worker’s comp insurance company fails to pay any of your necessary medical expenses to treat your injuries, an Orlando workers’ compensation lawyer can help you fight for the coverage you deserve.
Workers’ Compensation Should Cover Medically Necessary Emergency Department Care
Workers’ compensation covers the cost of medical care for job-related injuries and illnesses, including emergency medical treatment. However, under Florida’s workers’ compensation law, all covered medical care must be “medically necessary” and be related to the workplace injury.
Some examples that should be covered by your workers’ compensation insurance include:
- Serious lacerations or open wounds that require stitches
- Injuries that cause a loss of consciousness
- Fractures or dislocations
- Chemical exposure
- Significant burns
- Acute back, neck, or head injuries
If you would normally call an ambulance or go to the nearest emergency room for an injury, you should do the same if you were hurt at work. Your health must be your priority, and you should not have to worry about paying for the care you need.
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Can I Go to the Emergency Room Without Prior Authorization?
You do not need prior authorization from your employer or insurance company to seek care in an emergency room after an on-the-job injury. If you have a serious accident or significant injuries, you do not need to wait to get care.
Under Florida Statutes §440.13(3)(a), you can get emergency treatment for injuries without authorization if a delay could endanger your health or life. However, your insurance carrier will most likely only cover your costs if your injury truly requires immediate medical attention. You cannot go to the ER for an assessment simply to be seen faster when you could get pre-authorization and see an approved doctor without it affecting your health.
Can I Choose Which ER to Visit After a Florida Workplace Injury?
In an emergency, you can choose which emergency department to visit. The ambulance may take you to the nearest ER or the one best equipped to handle your injury. Sometimes, you may need to go to a facility further away to ensure they have the trauma expertise you need.
However, once your condition is stable, you must see a doctor approved by your workers’ compensation insurance provider. Continuing to see a doctor you chose without permission could jeopardize your claim.
What Will Happen After an ER Visit for an On-the-Job Injury?
During your initial visit to the ER, a medical provider will assess your needs and stabilize your condition. Once you are stable, how workers’ compensation covers your ongoing treatment differs from their coverage of your initial emergency room visit.
As soon as possible—and always within 30 days—you should notify your employer of your injury in writing. From there, you must ensure the workers’ compensation insurance company authorizes your continued treatment and you see their approved provider so your coverage will pay for your medical care.
Understanding how the Florida workers’ compensation claims process works can ensure your medical bills are covered after a workplace accident. This process includes:
- Going to the ER because of a medical emergency
- Receiving treatment in the ER
- Officially notifying your employer and filing a workers’ comp claim
- The insurance company reviewing the claim and determining you needed to go to the ER for a work-related injury
- Seeing an approved workers’ compensation doctor for your follow-up treatment
If you continue to see a doctor you choose for care after leaving the emergency department, you risk having the workers’ compensation insurance company refuse to pay for your continued treatment and care. It is necessary to follow the process, notify your employer, and see an approved doctor.
What If My Employer or the Insurer Denies My ER Claim?
Your employer may not cooperate with your workers’ comp claim, or the insurer might deny coverage for the cost of your emergency department visit for several reasons, such as:
- Your injuries are not work-related
- You did not require emergency room treatment
- You did not report the injury on time
- You were off the clock when the injury occurred
If you were hurt at work and required an ER visit, but the workers’ compensation company will not pay, your best resource is an Orlando workplace injury lawyer. They will work with you to challenge the denial and fight for the workers’ comp benefits you deserve.
Do I Have to Pay the Hospital Bill While I Am Fighting for Coverage?
While medical bills covered by workers’ compensation should go directly to the workers’ comp insurance carrier, hospitals may bill the patient directly in the early stages, while the insurer is investigating the claim or if they deny the claim.
Injured workers are often frustrated and alarmed when they receive an ER bill for thousands of dollars after a workplace injury. You are only responsible for paying this bill if your claim is not successfully approved. If your lawyer appeals the denial and gets your benefits approved, the insurer will cover this cost.
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If you were hurt at work, workers’ compensation should cover the cost of your ER visit, but in some cases, you may have to fight to get your treatment and care approved. Our workers’ compensation attorneys can help. We will protect your rights and fight for the benefits you deserve.
Bogin, Munns & Munns has been representing injured workers since 1979, and we have hundreds of years of combined experience. We have offices throughout Central Florida and treat our clients like family. Contact us today for a free consultation.
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