In a way yes, if the authorized doctor says you no longer need medical care for your injury, then that is the effective end of your medical coverage. You can also lose medical care if you refuse medical care that could correct your medical problem. If losing medical care is an issue, you should contact an experienced WC lawyer to discuss your case.
Stated another way, when you settle your workers’ compensation claim for a lump sum, you give up your lifetime medical benefits in return for a lump sum of money. From that point forward, the cost of the medical care becomes the responsibility of you, the injured worker.
There are advantages and disadvantages to giving up your Lifetime Medical Award.
Pros of Lifetime Medical Benefits: The insurance company pays for your medical care- you don’t have co-pays and deductibles to worry about. You don’t have to stay employed with the original employer. The insurance basically covers the bills.
Cons of Lifetime Medical Benefits: The burden of proof is on you forever– Just because the doctor says you need a specific treatment or diagnostic test does not mean that the insurance company will approve it. This means that even though you have the “lifetime” medical benefit, even if you have an Award Order stating so, you still have to show that the current treatment requested is reasonable, necessary and related to the workplace injury at every turn. The insurance company does not assume anything.
Medical providers generally require the insurance company to pre-approve your treatment – Medical providers have been burned by workers’ compensation insurance companies too many times. Having lifetime medical benefits does not mean that you can just go to the doctor whenever you want. The insurance carrier still has to pre-approve everything and they can (and will) deny anything that they believe does not meet the standard of reasonable, necessary and related to the workplace injury. This process slows down medical treatment.
We’re Your Work Comp Experts
Have you been injured on the job or contracted an illness due to an unhealthy work environment? If so, then the Norfolk workers’ compensation attorneys at Kalfus & Nachman PC can help you file your lawsuit. There are several laws that can affect on the outcome of your case, so it’s extremely important to have a workers' comp lawyer on your side to assist you through the entire process. Get help with your workers’ compensation lawsuit. We specialize in workers’ compensation and help employees who have been injured within the State of Virginia. Contact us today by calling (855) 880-8163.