Routine Medical Needs and Workers’ Compensation Benefits


Routine Medical Needs and Workers’ Compensation Benefits

Most injured workers have ongoing, routine medical needs in addition to needs related to their workplace injuries. When navigating the workers’ compensation system in Minnesota and your private health insurance, you may have some confusion about which treatments are covered by which insurance.

Workers’ compensation insurance pays for medical needs that are reasonably necessary to treat your workplace injury. A workplace injury arises out of the course and scope of employment. This means that you cannot get the workers’ compensation company to pay for:

  • Routine physicals and general health checkups
  • Vaccinations (unless required for treatment of a work injury, such as a tetanus shot)
  • Prescriptions for non-work-related medical conditions
  • Office visits, unless for treatment of your work injury

All of these medical needs should be billed through your private health insurance. If you do not have insurance, then you would need to pay out of pocket.

In contrast, workers’ compensation insurance pays for a variety of medical needs stemming from a work injury. It does not pay for your routine medical needs. Depending on the type of injury, needs after an injury can include:

  • Surgery to address the injury
  • Replacement glasses, dental devices, or artificial limbs
  • Nursing care or physical therapy
  • Supplies such as gauze, crutches, or a wheelchair

It all depends on which treatment your doctor and the insurance company’s “Independent Medical Examiner” decide is reasonably necessary to help you. Sometimes your doctor and the insurance company may disagree about treatment. In that case your doctor may need to provide more information, or the insurance company may dispute the treatment with a workers’ compensation judge.

You need to make sure that medical bills for your treatment go to the workers’ compensation company – the treatment should not be billed directly to you. If you or your private insurance company are getting bills, talk to your doctor’s office to explain that you have a workers’ compensation claim. The office may have to bill you directly if the workers’ comp insurance company initially denied your claim. In that case, talk to a lawyer about fighting the denial so you or your private health insurance do not have to cover the medical bills.

Need help getting medical treatment for your workplace injury? Joe Osterbauer, Esq. and the Osterbauer Law Firm stand up for injured Minnesota workers’ rights. Joe’s 27 years of workers’ compensation experience and his team’s speedy service combine to get clients the results they need. To schedule a free consultation, visit Osterbauer Law Firm online or call Joe’s office at (612) 334-3434.