I had an awful realization summarizing medical bills in preparation for a workers’ compensation trial; injured workers who aren’t exposed to COVID-19 are in for a nasty surprise due to the resurgent pandemic: having to pay deductible in denied or disputes workers’ compensation.
Due to the COVID-19, many hospitals in Nebraska are delaying non-urgent surgeries because of lack of space in hospitals. Often times orthopedic injuries which are the most common workers’ compensation injuries are deemed to be non-urgent.
Of course, if workers’ compensation cases are accepted a worker doesn’t have to worry about medical expenses. However, many workers compensation case are disputed. In disputed case, many workers fortunate enough to still have health insurance pay for surgeries with private health insurance.
But private insurance requires you to burn through a deductible in order to have insurance start paying benefits. Your typical white-collar weekend warrior or Crossfit mom typically waits until the year to have surgeries as they don’t have to pay the deductible because it was spent down through out the year
But because of delays in non-urgent surgeries, more injured workers paying for surgeries in disputed workers compensation cases with private insurance will need to pay deductibles for procedures delayed into 2021.
So what options do workers have in this situation?
The first option is to get a lawyer and file a workers’ compensation lawsuit if you haven’t done so already. This may seem self-serving, but under Nebraska law, if a medical bill is related to a workers’ compensation claim a provider must delay collections efforts until the case resolves. (Of course, if you need a surgery and] your employer or their workers compensation insurer is denying medical care, you should get a lawyer even if you don’t have to pay a deductible)
Other problems with COVID delays
Higher out of pocket medical costs aren’t the only hitch for injured workers due to surgical delays to due to COVID-19. Workers who need to miss work due to a medical condition only have 12 weeks of job protected leave under the Family Medical Leave Act. (FMLA) Delays in surgery due to COVID may prolong treatment and return to work beyond 12 weeks.
Earlier in the pandemic, I thought the silver lining of medical delays could mean more temporary total disability (TTD) for injured workers waiting for medical treatment. I still think that could be true, but I can also see employers being more aggressive in return to work or voluntold community service light duty work to get around paying lost income benefits. Voluntold light duty assignments are full of pitfalls for injured workers