What is reasonable and what is necessary can sometimes be subjective and not very clearly defined.
Every state has different laws regarding what workers’ compensation benefits covers and what they don’t. In general, workers compensation is guided by the theory of what is reasonable and what is not. Employers in Missouri are mandated to have workers’ compensation coverage to protect themselves if one of their employees is injured while working.
The trade-off is that if you file for workers’ compensation benefits, you can’t also sue your employer when you are injured. Workers compensation insurance also doesn’t cover non-economic damages like pain and suffering and emotional distress. The problem is that what is reasonable and what is necessary can sometimes be subjective and not very clearly defined.
There is no clear definition of procedures or treatment that are covered. Since the benefits are guided by a combination of the individual’s injuries and what will enable them to return to work, there are times when workers’ compensation benefits will cover medical treatment and other instances when they won’t.
If you are injured while working, it is important for you to hire the services of a St. Louis workers’ compensation lawyer to ensure that your claim is accepted and that you get all the help that you need to recover and get back to work.
What is Considered Necessary and Reasonable?
The items that are almost always covered by workers compensation include:
- Physician appointments
- Diagnostic tests such as x-rays, MRI or CAT scan to determine the extent of any damage
- Emergency hospital services
- Medications that are either prescribed or administered
- Necessary surgeries to repair injuries
- Medical devices such as wheelchairs, hearing aids, crutches, etc.
- Physical therapy on a finite basis
- Medical treatment related to getting you back to the point where you can return to work
- Chiropractic care
Things that may cause the workers compensation insurance to question their necessity:
- Experimental procedures or alternative medicines
- Extensive or repeated services if they aren’t helping
- Extensive treatment that is more than what would be expected for minor injuries
- More than three weeks of medical treatment for soft tissue damage that lasts more than three weeks
- Any treatment that is administered by a nonspecialist or not indicated for your diagnosis
Is Your Employer Denying Your Benefits?
If you are denied coverage for your medical services, then you have to go through a separate process to contest your denial of workers’ compensation benefits. Since you can’t sue your employer if you receive workers compensation benefits, knowing what your rights are and how to appeal a workers’ compensation decision is imperative to making sure that you get the services that are necessary and reasonable to help get you back on the job.
If you have been denied what you feel is necessary and reasonable treatment through workers’ compensation coverage, then it is important that you contact the Law Office of James M. Hoffmann. For more than 20 years we have been helping the victims of work-related accidents receive the compensation they and their families need.
Call us today at (314) 361-4300 or fill out our online case evaluation form to request a free consultation.