How non-compliance can affect workers’ compensation benefits

On Behalf of | Oct 20, 2023 | Workers' Compensation

Injured workers whose conditions stem from their employment are usually eligible for benefits that can help to reduce the financial impact of their health concerns. The medical coverage available through workers’ compensation is valuable even if someone already has basic health insurance coverage. After all, the average insurance policy passes quite a bit of the cost of care back to the patients. Workers’ compensation does not.

Workers can count on receiving full coverage for any necessary treatment and the cost of ongoing symptom management when they have a work-related health challenge. Workers can also receive disability benefits while they’re unable to work. Yet, sometimes, workers end up losing their eligibility for health benefits and possibly awesome disability benefits due to mistakes they make after initiating a worker’s compensation claim. For example, medical non-compliance is surprisingly common and can undermine someone’s right to both medical coverage and wage replacement benefits.

What is medical non-compliance?

When a patient has recommendations from their physician to receive certain types of care, including surgery, physical therapy or prescription drugs, they generally need to follow through with those recommendations. Failing to do so can prevent someone from recovering. Intentional medical non-compliance would make someone’s lingering symptoms largely their own fault. Therefore, businesses can point to someone’s refusal to attend physical therapy or fill a prescription as evidence that their continued need for benefits is their own fault. At that point, a worker might be at risk of losing both ongoing medical coverage and disability benefits if they cannot return to work because of how their symptoms affect their functional ability.

What if a worker disagrees with the treatment plan?

Injured workers do not always agree with what a physician recommends for their care. Thankfully, they do have the right to seek a second opinion. If the treatment is surgery, workers’ compensation will cover a second opinion. Otherwise, the worker will likely need to pay for their own care. Those with notes from a physician recommending different care may have an easier time negotiating with an insurance company or the physician overseeing their workers’ compensation claim to adjust their treatment plan.

Injured workers need to be careful to properly abide by medical recommendations and the general requirements for the workers’ compensation program if they hope to continue receiving benefits until they improve enough to return to work. Avoiding the most common mistakes injured workers make may benefit those hoping to recover from a job-related health issue while maintaining their access to benefits.