A work injury can lead to medical bills fast. In Virginia, workers’ compensation may help pay for treatment related to the injury, but coverage depends on the facts of the claim. Knowing what expenses may be covered can help injured workers avoid surprises.
What treatment may be covered?
Virginia workers’ compensation law generally covers reasonable and necessary medical care related to a work injury. That may include doctor visits, hospital care and surgery. It may also cover physical therapy, prescription drugs and tests such as X-rays or MRIs.
Workers’ compensation may also cover emergency room care and follow-up treatment. If a doctor orders durable medical equipment, such as crutches or braces, that cost may be covered too. In some cases, counseling related to the injury may also qualify.
Are there limits on coverage?
Whether a provider authorizes the treatment and relates it to the work injury usually determines coverage. In some cases, a worker may need to follow specific treatment rules or use providers approved under the claim. If a worker gets care without following those rules, the insurer may dispute payment.
Coverage may continue while the treatment remains reasonable, necessary and tied to the injury. Insurers may still question whether a worker needs a procedure or therapy. If that happens, the worker can challenge the denial through the Virginia workers’ compensation system.
Getting the care you need
If the insurer denies a medical bill, identify the reason for the denial. Review the treatment records, the doctor’s notes and the claim file to determine if the insurer should have covered the charge. If the insurer still refuses to pay, legal guidance may help you decide what to do next.
