• Lifetime Medicals Under Virginia Workers' Compensation
  • October 3, 2014 | Author: Joseph A. Miller
  • Law Firm: Joe Miller Law, Ltd. - Norfolk Office
  • When you are injured in a work-related accident and you file a workers’ compensation claim, there are certain benefits that you may be eligible for. One of the benefits is Lifetime Medicals. In this article we will explain what Lifetime Medicals are and what you need to do to ensure you get Lifetime Medicals for your injury.

    What are Lifetime Medicals?

    Under Virginia Workers’ Compensation there are certain benefits that you may be entitled to when you are injured at work.  One of the benefits is lost wages to make up for time the worker has missed from work due to the injury. This is commonly referred to as temporary total disability or TTD for short. That benefit is paid at 2/3rds of your average weekly wage and this benefit is limited to 500 weeks, meaning you can get paid only up to a maximum of 500 weeks for your injury.  The only exception to this cap is if you can prove you have an extremely permanent and serious disability as a result of the work injury involving two ratable body parts.

    Unlike lost wage or TTD benefits, lifetime medicals, as the name implies, means you are entitled to those medical benefits for the remainder of your life. As long as you do what you are supposed to and you suffered a compensable injury, your medicals for that specific injury will be covered for your lifetime. That benefit can be used for prescriptions needed for that injury, surgery, in-home care, physical therapy, the cost of mileage to and from doctor appointments, along with wheelchairs, medical equipment and a host of other medical needs related to your work injury.

    What do I need to do to make sure I get Lifetime Medical Benefits?

    There are several things you need to do in order to ensure you obtain lifetime medical benefits and that those benefits continue and are not cut off by the insurance company.

    First of all, you have to file your workers’ compensation claim in a timely manner. Also, the medical bills you are trying to get covered have to be reasonable and related to your work injury or illness. You must usually use one of the three doctors on the panel that the employer will present to you when you are injured. That doctor will become an authorized treating physician. You must also follow the advice and treatment protocols of other doctors and healthcare providers that your primary treating physician may refer you to.

    The Importance of an Award Order

    Secondly, and most importantly, in addition to filing your claim, assuming that it becomes an accepted claim by the insurance company, you must then insure that the Virginia Workers Compensation Commission issues an Award Order that recites that the employer is required to pay you Lifetime Medical Benefits for your claimed injured body parts. If you do not obtain such an Award, then you have no right to Lifetime Medical Benefits.

    Without an Award Order, payment by the insurance company for your treatment could be cut off at any time, without any notice to you. Without an Award Order, the only way to require the insurance company to pay for your treatment is by obtaining such an Award Order through agreement or by way of a hearing before the Commission.

    Changing Doctors and the Risk of Losing Medical Benefits

    You cannot change doctors in the middle of treatment unless you get the agreement of the employer or the employer’s carrier, or you file the appropriate Motion with the Workers Compensation Commission. The motion to change treating physicians will only succeed if the doctor is no longer providing appropriate medical care, or simply refuses to treat you further for your work-related injury.

    Finally, you must follow your treating doctors’ advice as well as the advice of the health care providers to whom that doctor refers you, or you risk having a Motion filed against you by the employer to cut off your benefits. If that happens, your benefits will stop almost immediately, even before the hearing.

    Paying for your Own Doctor

    All that being said, if you are dissatisfied with your authorized treating doctor and you have sufficient funds to seek medical care on your own, or you have a health insurance policy that will pay for such care, there is nothing preventing you from seeking treatment on your own with any doctor you like.

    This is important to know in the event you disagree with the course of treatment or opinion of your authorized treating doctor. The Commission will be more than happy to listen to what the doctor you have chosen on your own has to say, if a dispute arises regarding your medical care.

    The Complicated Nature of Workers Compensation

    If you have been injured at work there are a lot of things you need to take under consideration. You need to file a claim, deal with the adjuster, get treated by the right doctor, report your injury to your employer in a timely fashion. If you do not follow the law and properly enforce your rights, you will have no rights.