If you have suffered an injury while working or you have been diagnosed with an occupational disease, you will need to get medical care to treat your condition and to help your recovery. Workers' compensation is a state-mandated program, so while the laws vary from one state to another some things are usually very similar. Each employer is contracted with a workers' compensation insurer. That insurer is contracted with different medical providers who will provide care and services to injured or ill workers. Your employer should have a list of approved providers posted in an accessible place at work. Usually, this list is in a break area or by a time clock. These physicians have contracted with the workers' compensation insurance company and agree to the workers' compensation reimbursement rates. The workers' compensation reimbursement rates are the agreed medical fees that the insurer will pay the medical provider for the services rendered. Who Sets Fee Schedules? Usually, the State Board of Workers' Compensation establishes the compensation fee schedules for that state. In addition to determining medical reimbursement fees, they also set the payouts for short-term and long-term disability through workers' compensation. Usually, you will be paid about two-thirds of your regular salary up to a maximum payout established by the board. The state laws regarding fees and payout vary significantly, but your workers' compensation attorney, your employer, and your employer's insurer do have access to these fee schedules and should be able to determine how to provide you with the best care and ensure you receive the benefits that you are entitled to receive as part of your workers' compensation claim. What Is Included in Fee Schedules? The fee schedule establishes payment for dental and medical care required as part of a workers' compensation claim. The fee also establishes the diagnosis and procedure coding that must be used in order for a provider to be properly reimbursed per the fee schedule. It also sets the requirements for the medical providers. As an example, the fee schedule might require an ambulatory surgery center that provides workers' compensation services in the state to be certified by Medicare. Holiday reimbursement rates might vary from the standard reimbursement rates as well. There can be a reimbursement limit set for some services, such as preparing functional capacity assessments or evaluations. Consult With A Workers' Compensation Attorney If you have suffered injuries in a work accident or if you have been diagnosed with an occupational disease, you should consult with a workers' compensation attorney. Your attorney will investigate your claim, gather up supporting evidence and documentation, file your claim and ensure you are treated fairly and that your rights are protected. Workers' compensation laws can vary significantly from one state to another, so make sure you get a workers' comp lawyer from your state to aggressively pursue your claim. A work-related illness or injury can leave you facing a long road to recovery. Don't wait until it is too late to file your claim. Schedule a free case evaluation today. Additional Resources Workers’ Compensation Insurance Companies Denied by Insurance?
