The employer’s workers’ compensation insurance company is responsible for an employee’s medical bills, if the bills are reasonable and are related to the care of an injury suffered by the employee in the course of work. That is a simple proposition, but as the workers’ compensation lawyers at Winer and Bennett, LLP, know, in practice it is frequently complicated.
It is not uncommon for the insurance company to hire a physician of their own to review the medical records and to sometimes examine the injured worker. An injured worker is obligated to cooperate with such medical exams no more than twice a year and no more than 50 miles from home. Frequently, the insurance company’s physician will disagree with a treating physician’s recommended care, giving the insurance company grounds to refuse payment. When that happens, the recourse is requesting a hearing at the New Hampshire Department of Labor. A Hearings Officer will hear the testimony, review the medical evidence and decide the issue. Each party has the right to appeal that decision to a 3 member Compensation Appeals Board for a rehearing. That’s important due process, but pending the appeal, medical bills ordered to be paid by the Hearings Officer don’t have to be paid until and unless the same decision is issued in the appeal. The appeal customarily takes 6 months.
Other potential issues relating to medical bills include whether they were for the care of a medical condition caused by work activity, whether the injury resolved and the care is unreasonable, whether more than 18 months passed since the insurance company’s denial (in which case the denial is final), whether the required supporting documentation has been provided by the care provider, whether the care is unreasonable because it was unconventional.
When you’re injured at work, you enter a world where your rights and duties are governed laws, regulations and practices you’re probably not very familiar with. You should have the guidance and advocacy of someone who knows that law. For that legal counsel, call one of Winer and Bennett’s workers’ compensation lawyers at (603) 882-5157.