In many instances, an employee injured at work is also covered under a private health insurance plan. What happens where a workers’ compensation insurance carrier refuses to pay for treatment that has been billed to them? Can it simply be billed to your private health insurance carrier for payment? The answer to this lies in the specific language contained in your health insurance policy. Most people have never seen the entire policy and don’t know exactly what it says.
While workers’ compensation should pay for work related medical treatment many issues arise where treatment is denied. For instance, where a medical provider has failed to comply with billing time frame or regulations under the New York State Workers’ Compensation Law, an insurance carrier may properly deny payment. Our advice is to have your doctor resubmit the bill to your private health insurance carrier.
Many private health insurance policies state that if workers’ compensation is not liable, the private policy will cover the treatment. However, this is not always the case. Often times, a simple phone call to your private health insurance carrier’s customer service department will clarify whether or not your private health insurance will cover a specific treatment that has been denied by Workers’ Compensation.