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Why Your Claim May Be Denied Even If You Have Lifetime Coverage Under Workers Comp

Workers compensation laws are a fairly complex piece of legislation, and it can be very difficult to go through them without a broader understanding of the legal system.

man upset after workers comp benefits are denied

When you apply for workers compensation benefits, you may be asked to make a very important decision: settle the claim or keep lifetime medical coverage. However, without knowing the pros and cons of both of them, many workers can end up making the wrong decision.

What Are Your Options if You Are Injured?

When you get injured at work and file for workers compensation, you can either receive a full settlement in a lump sum or opt to retain your lifetime medical coverage.

The process is faster if you opt for the lump sum. Once the settlement is decided, you get to decide how to spend it. So, you do not have to wait for approval from the insurance company, and may even get to see any doctor you want. However, this option also implies giving up your lifetime medical coverage.

If you opt for lifetime medical benefits, however, you get coverage for all your treatments, without having to worry about co-pays or deductibles. Missouri law states your worker’s comp insurance will cover the cost of your treatment.

However, you will have to get approval from the insurance company before any treatment you get, and you’ll most likely have to see a doctor they choose. Missouri law states your employer and insurance companies have a right to choose your physician, though they are not allowed to choose or influence the course of treatment.

Can Your Claim Be Denied with Lifetime Medical Coverage?

Yes. By opting for lifetime medical coverage, you will need approval from the insurance company at all stages of your treatment. Essentially, this also means the insurance company will analyze your case every time a new request is made to see if what you are asking for is relevant to your case or not.

With lifetime medical coverage, you have a permanent burden of proof. In a lump sum, the insurance company does not care what you do with the money once the settlement is decided. But in the context of lifetime coverage, they take a much more hands-on approach. As a result, it is possible for a claim to be denied if the insurance company considers the treatment to be irrelevant or not necessary.

What Can You Do?

Just because the insurance company denies the claim, it does not mean you have no other choice but to cover the treatment yourself. If you work with an experienced St. Louis workers comp lawyer, they can help you gather evidence to show your treatment is necessary, begin negotiations, and protect your legal right to compensation.

Give us a call 24/7 at (314) 361-4300 for a FREE and PRIVATE case evaluation.