What Are Pennsylvania Workers’ Compensation Medical Benefits?

If you’ve been injured at work or diagnosed with a work-related illness, you are entitled to receive medical treatment that is reasonable, necessary, and related to your condition. These medical costs are the responsibility of your employer and the employer’s workers’ compensation insurance carrier. Once a claim is accepted, you should never have to make a co-payment or pay any other fee for medical care associated with a work-related injury, or illness.

Unfortunately, the phrase “reasonable, necessary and related” leaves the door wide open for insurance providers to dispute the types of treatment available under medical benefits coverage.

We’ll Help You Get The Medical Benefits You Deserve

At Wolf, Baldwin & Associates, P.C., our workers’ compensation medical benefits lawyers have been helping injured workers in southeastern Pennsylvania for more than three decades. We have represented thousands of clients with many different types of work injuries. There is almost no type of injury or medical benefits problem we have not encountered.

If you are having problems getting medical care, we put our experience to work for you. Contact our Pennsylvania law offices to schedule a consultation. You can rely on us to help you resolve your workers’ compensation concerns as promptly and efficiently as possible.

What Kinds Of Medical Benefits Can I Get?

If you were hurt on the job, you are entitled to receive medical treatments at no cost to you. Here are some of the medical benefits you may receive, depending upon your medical needs:

• Doctor visits — Under Pennsylvania workers’ comp law, if your employer has published a list of approved panel doctors, you must seek treatment from one of those doctors for the first 90 days. If you get treatment from your own doctor rather than a doctor on the posted list, your medical expenses may not be paid. If your employer does not have a posted list of approved doctors, then you are free to choose your own doctor. After the first 90 days (after the injury), you can go to a doctor of your own choosing, and that doctor’s medical bills will be paid by workers’ comp.
• Surgery and hospital expenses
• Prescription drugs and other medications (including over-the-counter medicines, such as aspirin)
• Medical devices and supplies, such as walkers, wheelchairs, or braces

You are also entitled to receive these benefits if your work has caused an aggravation of a pre-existing condition. These types of claims are often denied, but can be successfully appealed with the help of our attorneys.

It’s important to note that receiving payment for your medical expenses does not necessarily mean you have been approved for Pennsylvania workers’ comp wage loss benefits.

You May Also Be Eligible For Specific Loss Benefits

If you have lost a limb, eyesight or hearing, or have a permanent disfigurement (visible scarring of the face or neck), you may be entitled to receive a lump sum of disfigurement benefits from workers’ compensation. These types of losses have a defined dollar value, based on a number of weeks of compensation benefits.

Are You Being Offered A Lump-Sum Settlement?

At other points along your recovery, you may be offered a lump-sum settlement for your current and future medical expenses. It may or may not be a good idea to accept that settlement, depending upon your situation. You may have already settled your wage loss benefits at an earlier time, or may be negotiating a settlement of both wage loss and medical benefits at the same time. Either way, having an experienced workers’ comp attorney on your side is essential to obtaining a fair settlement.

Once you have completed the majority of your medical treatment and have arrived at a point of recovery where your doctor believes no further significant medical improvement will occur (a point called maximum medical improvement, or “MMI”), you may be offered a lump-sum settlement for any remaining degree of disability. This settlement should be negotiated by your attorney, because the workers’ comp insurer will tend to understate the degree of remaining disability in order to pay less.

Settling a medical benefits claim is even more complicated when you are also Medicare eligible or receiving Social Security Disability benefits. Consultation with an attorney is an absolute necessity in these cases.

Related Articles For Further Information

• “Medical Treatment Under the Workers’ Compensation Law”
• “Receiving Workers’ Compensation and Collateral Benefits“
• “Terminating Workers’ Compensation Medical Benefits“

Talk To Us About Workers’ Comp Medical Benefits

Offices in Pottstown, Pennsburg, West Chester, and Reading, Pennsylvania, serving clients in Exton, Glenmoore, Kennett Square, North Coventry Township and Paoli

Call 610-228-4582 | Toll Free: 610-228-4582

Before you accept any lump-sum payment for your medical expenses, talk with the Pennsylvania workers’ comp law firm of Wolf, Baldwin & Associates, P.C. We can answer your questions regarding proper medical treatment for a workplace injury or occupational disease, and help you understand your rights to medical benefits.

To learn more about medical benefits for injured Pennsylvania workers and how our lawyers can help, call our offices, or contact our work injury lawyers online for a free consultation.

Referrals Welcome / Language Translation Services Available at No Cost