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Understanding medical benefits through workers’ compensation

| Jan 29, 2016 | Workers' Compensation

For a person in Montana who is a work accident victim, there are many concerns that will come to the forefront. Workers’ compensation benefits are meant to assuage a large number of those worries. However, there are certain factors that must be considered when it comes to workers’ compensation. If there is a disagreement or confusion, it is imperative that the workers know their rights under the law.

Through workers’ compensation, medical benefits are provided. This will be contingent on the insurer approving the claim. The worker is allowed to have any reasonable medical expenses paid for. There will be a schedule under which the medical fees are paid. The worker will not be responsible for paying the difference between what is charged and what is paid by the insurer. It must be remembered that workers are not allowed to choose their medical provider. Initially, the worker is allowed to choose the treating physician. After the insurer has accepted liability, a different physician can be designated by the insurer or the current physician can be approved.

The worker will not be able to receive medical benefits for an indefinite period. They will end 60 months after the date in which the injury occurred unless the worker is deemed to be totally disabled or has a prosthesis. When the termination of benefits is approaching, the worker must request that the medical benefits reopen when there are no more than 90 days left in the 60 month period. Workers will have to pay $25 for the cost of each emergency room visit after the initial visit.

In some instances, workers have to travel for treatment. If so, the insurer will pay a certain amount of the costs. The first 100 miles each month are excluded. If there is a comparable treatment available in the community, then the travel fees will not be paid outside of the community. Disallowed or unauthorized treatments or procedures for which the claimant has to travel will not be paid for through workers’ compensation benefits.

Those who receive workers’ compensation after being injured at work need to understand the rules for treatment and medical costs. When the injury occurs, it is wise for the worker to discuss the matter with an experienced legal professional.

Source: erd.dli.mt.gov, “Workers’ Compensation Benefits Summary for dates of injury occurring on or after July 1, 2015 through June 30, 2016 — Medical Benefits,” accessed on Jan. 25, 2016

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