You were injured on the job and you need to either spend some time in a skilled nursing facility when you leave the hospital or have at-home nursing care. However, part of your workers compensation claim that would cover the cost has been denied. That doesn't seem right to you. An attorney who handles workers comp claim denials can help. You may very well deserve payment for your nursing care as you recover from your injury.
What Workers Compensation Covers
At its most basic, workers compensation insurance pays for medical expenses after a work-related injury and a substantial amount of the person's lost wages. It also is intended to cover reasonable and necessary care and items such as:
- physical therapy
- occupational therapy
- skilled nursing assistance at home or in a care facility
- prosthetic devices
- hearing aids
- walkers and wheelchairs
- modifications to your home and car to accommodate your disability
If any of your family members will assist you with at-home care, they can be compensated comparable to the money a nursing assistant would earn. This is not intended for round-the-clock care, however.
What Workers Compensation Does Not Cover
This program does not cover intangible aspects such as pain and suffering or temporary loss of ability to do one's usual activities.
This may seem unfair, but workers comp does not function like a personal injury lawsuit. Instead, it protects the employer from lawsuits and protects employees from having to prove that the employer was directly at fault for the injury. That's why an employee can receive workers comp benefits for a condition such as carpal tunnel syndrome, which may not involve any fault by the employer.
Why Certain Aspects of Workers Comp Claims Are Denied
Depending on the circumstances, the insurance company may attempt to avoid paying for added benefits and dispute the need for them. Essentially, the insurance company and the employer want to save money. The employer doesn't want workers comp insurance premiums to go up and the insurance carrier doesn't want to pay more than it has to.
They might encourage you to use your health insurance benefits instead, but that is not your responsibility.
What You Can Do Now
Consult a lawyer if you believe you are not being compensated fairly. You'll need to provide verification that ongoing skilled nursing care is essential for the time being. You can obtain this verification in writing from your family doctor, surgeon or other specialist. The verification may be in the form of a prescription. Your lawyer will appeal your claim and help you get the money you deserve.
For more information, contact your a local law firm to find an experienced attorney.