When does workers’ compensation medical coverage end?

On Behalf of | Sep 20, 2023 | FAQs

Employees who get hurt while at work often have a laundry list of concerns. They worry about whether they will lose their job because they need an extended leave of absence. They may also worry about how they will cover the cost of medical treatment while away from their job and therefore not earning their typical income.

The good news for someone injured at work or recently diagnosed with a job-related medical condition is that workers’ compensation in Pennsylvania will typically cover the cost of their necessary medical treatment. They can also potentially ask for accommodations that align with their physician’s recommendations to help them get back to work more safely.

There are no statutory limits for necessary care

Unlike certain kinds of benefits that are subject to a maximum total value or a limited number of months, medical coverage provided by workers’ compensation can last for the rest of someone’s life. Provided that the care or treatment is necessary to control someone’s symptoms or improve their condition, workers’ compensation can continue providing full coverage indefinitely.

However, there are scenarios in which medical benefits me and or change. Those who make a full recovery will stop receiving coverage for future treatment, as no additional treatment is necessary. Those who reach maximum medical improvement (MMI) will find that their benefits change. They may only qualify for coverage related to ongoing symptom management and not treatment, as a doctor has affirmed that they will likely not improve with additional interventions.

Finally, there are some workers who may lose their medical coverage because they failed to follow through with medical recommendations. Not informing an employer of job restrictions or failing to follow a treatment plan could result in the termination of someone’s medical benefits because their non-compliance is partially to blame for their ongoing symptoms.

Workers need to know their rights if they expect to make use of them after acquiring an injury or illness related to their employment. Learning more about the rules for medical coverage and other Pennsylvania workers’ compensation benefits can help those with job-related health issues receive the support they deserve.