When Does the Employer Have to Pay for Emergency Medical Treatment Related to a Compensable Work Accident?
Did you receive an award for lifetime medical benefits after presenting your case at a workers compensation hearing? Did the employer accept your claim for workers compensation benefits and provide an Award Agreement form? If you answered yes to either question then this article is for you.
Take a look at the judicial opinion awarding you workers comp benefits or the Award Order entered by the Commission after you filed an agreement form. You’ll see that the employer is responsible for the payment of medical treatment that is reasonable, necessary, authorized, and related to your compensable work accident.
Authorized is the key word. The employer does not pay for medical treatment unless it is authorized – even if it is reasonable, necessary, and related to your work injury. The fact that the unauthorized treatment is an acceptable method of treating your condition is not, by itself, sufficient to force the employer to pay for it. Shenandoah Prods., Inc. v. Whitlock, 15 Va. App. 207 (1992).
If the employer doesn’t have to pay for it then you do. And medical care isn’t cheap. One hospital bill can lead to bankruptcy.
There is, however, an exception to this rule.
Virginia Code Section 65.2-603(C) states:
If in an emergency … or for other good reasons, a physician other than provided by the employer is called to treat the injured employee, during such period, the reasonable cost of such service shall be paid by the employer if ordered to do so by the Commission.
This is a fancy of way of saying that the employer has to pay for emergency medical treatment related to your work injuries even though the treatment is unauthorized.
What is Emergency Medical Treatment?
Once an injured employee has accepted authorized medical treatment, alternative treatment is not the employer’s responsibility unless such treatment is (1) specifically authorized by the employer, (2) emergency treatment, or (3) authorized by the Commission.
The employee has the burden of proving that emergency medical care provided by anyone other than an authorized physician should be paid by the employer. See Insurance Management Corp. v. Daniels, 222 Va. 434, 438, 281 S.E.2d 847, 849 (1981). He must show that there was no opportunity to obtain medical treatment from his authorized treating physician. Duty v. Skeens Fork Coal Company, Inc., 73 O.W.C. 156 (1994).
The Commission will find the employer is responsible for unauthorized medical treatment if the employee reasonably believed that his medical condition required emergency care. Bernhard v. Crown, Cork & Seal Co., Inc. 68 O.I.C. 198 (1989). Once the emergency ends, however, the employee must contact his authorized treating physician. He cannot refuse to return to his authorized doctor and expect the employer to pay for additional treatment.
In Payne v. Master Roofing & Siding, Inc., 1 Va. App. 413 (1986) the employee’s wife called his authorized treating physician’s office numerous times. When she was unable to reach the treating physician, the claimant sought treatment from the emergency room. The Court of Appeals found that the claimant acted reasonably and that the employer was responsible for payment.
In Loudoun County School Board v. Kobstecka, No. 3106-02-2 (Va Ct. of Appeals June 17, 2003) the employer was required to pay for treatment with an unauthorized orthopedic surgeon when the employee was in severe pain and her authorized physician was unavailable.
These cases are illustrative. The Commission will look at the following when deciding whether the employer is responsible for unauthorized medical treatment:
- How severe were the claimant’s symptoms? The more severe, the more likely the Commission will authorize the employer to pay for emergency treatment.
- Were the claimant’s symptoms related to the work injuries?
- Did the claimant make an effort to contact his treating physician?
- How many times and over what period did the claimant try to contact his treating physician? The more attempts you made the more likely the Commission will require the employer to pay for unauthorized care.
- Would the claimant’s condition have worsened permanently if he did not obtain the medical care?
Emergency medical treatment is expensive. Make sure you build your case so that you aren’t left on the hook for it.
Get Workers Compensation to Pay for Emergency Medical Treatment
As a Virginia work injury lawyer I hate seeing my clients make innocent mistakes that put them in a difficult financial situation. If you have a question about your case or obtaining medical care, contact Corey Pollard today. We’ll help you preserve your legal rights and negotiate a top-dollar workers comp settlement.
If your medical condition is severe enough to prevent you from returning to work we’ll also help you get approved for Social Security Disability Insurance (SSDI) benefits. As a Richmond disability lawyer and Newport News SSD attorney I do everything I can to help injured workers obtain compensation and medical coverage through all available options.