Medical benefits are an important benefit under the Michigan workers compensation laws.
A worker who suffers a work-related injury is entitled to reasonable and necessary medical care for work-related injuries or diseases. This includes payment of expense for all medical treatment, including surgery, physical therapy, rehabilitation, and hospital services.
Employers or their insurance carriers are required by law to provide these services and benefits must paid as long as the treatment is related to a work injury.
Michigan law does not require prior authorization from the employer or insurance company for medical services. However, it does allow the employer to direct the care for the first twenty-eight days of medical care.
Many large employers have company clinics and doctors that will see and treat the injured worker and refer to an outside specialist if necessary. After the four-week period, the employee may choose their own treating physician.
Typically, the doctors and other medical providers send their bills directly to the employer or its insurance carrier.
There is a specified fee schedule for services and doctors and hospitals are not permitted to charge more than the set fees. If they do charge higher fees, the insurance company will only pay according to the fee schedule. A worker who incurs out of pocket expenses is entitled to reimbursement.
Many times, the employer will unlawfully refuse to pay for necessary medical care and treatment. Other times, the company doctor or an insurance medical examiner (IME doctor) will give an opinion that an injury is not work-related or that medical treatment is no longer necessary and medical benefits will be terminated.
What are the Most Common On-the-Job Injuries?
Worker's compensation claims can be filed for any type of work related injury or disease. The most common injuries are:
What Are My Legal Rights If My Employer Denies My Benefits?
Although the workers’ compensation system was designed to help the injured worker, the fact is that many employers and insurance companies dispute claims and refuse to pay benefits. You may have had your benefits cut off by a company doctor or insurance medical examiner, even though you are still disabled and in need of treatment. This can happen shortly after your injury or even many years later.
If your benefits are denied or terminated, you must file an Application for Mediation or Hearing with the Michigan Workers’ Compensation Agency. This starts the legal process for your claim to unpaid benefits. Your employer or the insurance company will likely dispute your claim, so it is important that you are represented by an experienced attorney.
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