DOES YOUR PLAN COVER YOU ON AND OFF THE JOB

1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?

Many health insurance plans have specific exclusions that eliminate your benefits for anything that could have been covered under Workers Compensation or similar laws. Now read that last sentence again.

COULD HAVE BEEN COVERED!? That is correct. Most self employed people. Even some small business owners do not carry Workers Comp on themselves. Most self employed people and even some small business owners do not carry Workers Comp on themselves.

There are designed insurance plans that will cover you on and off the job - 24-hours a day, if you are not required by law to have Workers Compensation coverage.

2. ARE YOU WRITING IT OFF?

Independent contractors (1099’s), home based business owners, professionals and other self employed people generally are not taking advantages of the tax laws available to them.

Many people who are paying 100% of their own costs are eligible to deduct their monthly insurance payments. Just that alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accounting professional if you are eligible and/or check out the IRS website for more information.

3. INTERNAL LIMITS All true insurance plans use some form of internal controls to determine how much they will pay out for a particular procedure or service. There are two basic methods.

-Scheduled Benefits

Many plans, some of which are specifically marketed to self employed and independent people, have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hr. period. This structure is usually associated with “Indemnity Plans”. If you are presented with one of these plans, be sure to see the schedule of benefits, in writing. It is important that you understand these type of limits up front because once you reach them the company will not pay anything over that amount.

-Usual and Customary

“Usual and Customary” refers to the rate of pay out for a doctor office visit, procedure or hospital stay that is based on what the majority of physicians and facilities charge for that particular service in that particular geographical or comparable area. “Usual and Customary” charges represent the highest level of coverage on most major medical plans.

4.YOU HAVE THE ABILITY TO SHOP!

If you are reading this you, are probably shopping for a health plan. Every day people shop, for everything from groceries to a new home. During the shopping process, generally, the value, price, personal needs and general marketplace gets evaluated by the buyer. With this in mind, it is very disconcerting that most people never ask what a test, procedure or even doctor visit will cost. In this ever-changing health insurance market, it will become increasingly important for these questions to be asked of our medical professionals. Asking price will help you get the most out of your plan. Reduce your out-of-pocket expenses.

5. NETWORKS AND DISCOUNTS

Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In broad strokes, networks consist of medical professionals and facilities who agree, by contract, to charge discounted rates for services rendered. In many cases the network is one of the defining attributes of your program. Discounts can vary from 10% to 60% or more. Medical network discounts vary, but to ensure you minimize your out-of-pocket expenses, it is imperative that you preview the network’s list of physicians and facilities before committing. This is not only to ensure that your local doctors and hospitals are in the network, but also to see what your options would be if you were to need a specialist.

Ask your agent what network you are in, ask if it is local or national and then determine if it meets your own individual needs.

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Seeing A BWC Approved Doctor For Workers’ Comp Care

When you're injured in a fork-lift accident at your warehouse job or think you may have developed carpal-tunnel syndrome at your office job, your first move may be to go to the nearest emergency room or your doctor for diagnosis and treatment.

Fortunately, the Ohio workers’ compensation program allows this-but only for that initial visit.

After that, you must see a Bureau of Workers’ Compensation (BWC)-certified physician for your treatment to be covered by workers’ comp. If you work for a self-insured employer such as UPS or Ohio State, your employer will decide regarding your eligibility and who you can see for treatment.

Finding a Certified Doctor

It's possible that your doctor is already BWC-certified-in which case, you won’t have to look further for a doctor to treat your work injury. However, if she's not and you continue to see her, you'll be responsible for all medical costs related to your work injury.

While your employer may suggest a doctor, you're under no obligation to visit that doctor. Instead, you can find a certified physician in your area by checking the provider look-up tool on the BWC’s website. As long as you receive workers’ comp benefits for the injury for which you're seeking treatment, medical costs related to your claim will be covered.

However, even for BWC-certified doctors, treatment has to be approved by your employer’s managed care organization (MCO) with employers who obtain workers' compensation through Ohio's state insurance fund or by your self-insured employer.

Getting Approval From Your MCO

If you're not already familiar with managed care organizations, understand how they work.

All employers who purchase workers’ comp insurance through a state fund must choose one of 13 MCOs recognized by the BWC to manage their workers’ compensation claims. The MCO oversees claim filing, and supervises medical treatment and employer return-to-work programs. Your employer’s MCO manages the medical portion of the claim, so additional medical procedures, treatments, and referrals from the treating physician have to be approved by the MCO.

If medications are prescribed, you have to inform the pharmacist that it's a workers’ comp claim and provide your BWC claim number. Any treatment or services you received before your workers’ comp claim is approved should be reimbursed after that approval. Note that some large Ohio employers are self-insured-this means they administer workers’ compensation claims directly, and your employer may manage the medical portion of your application.

Having Trouble? Call an Experienced Workers’ Comp Attorney

If you're like most of our clients, you may feel frustrated and hopeless when coverage for a needed medical procedure or prescription is denied. However, you may appeal any medical decisions made by your MCO, and you may work with an experienced workers’ comp attorney on your appeal.

If you feel like the BWC is saying you and your doctors are wrong, or even fraudulent, call me for a free review of your claim. I help many workers just like you overcome the challenges of the Ohio workers’ comp system, and I may assist you, too. We're never too busy to take your call or answer questions. Fill out the form on this page to connect with me today.

Myths About Arizona Workers' Compensation

Getting injured on the job is an unfortunate reality for many Arizona residents. And while you always hope it never happens to you, if it does-you need to know what steps to take. For situations such as these, Arizona Workers' Compensation lawyers exist to act as your guide. Here are a few myths that may keep you from obtaining the help you need. Don't let them!

Myth: It's just as easy to obtain Workers' Compensation on your own.

Fact: Not at all. When you go it alone, the odds are against you. You're just an individual. An injured worker. Why does anyone have to listen to you? As far as the opposing party is concerned, you have no clue what you're talking about and they have no reason to fear you. But when you get an Arizona Workers' Compensation attorney on your side, you level out the playing field.

Myth: Obtaining an Arizona Workers' Compensation attorney will cost you a fortune.

Fact: It's actually more affordable than you might think. First of all, you're going to get a free consultation. During this time, you'll get to sit down with the Arizona Workers' Compensation lawyer and discuss your case a bit. He'll tell you if you really have a fighting chance, and then you'll start planning. And at this point, you haven't paid one single penny!

Myth: If you've been denied Arizona Workers' Compensation, it's all over.

Fact: The right attorney can help you get benefits after you've been denied. He'll know exactly what steps to take to get you the benefits you need and deserve. So don't throw in the towel just because one door closed in your face. You need to keep knocking.

Myth: Arizona Workers' Compensation lawyers are too busy to deal with you themselves.

Fact: It depends on who you hire. When you find a really good lawyer, you'll receive the personal attention you deserve. But if you hire a prima donna lawyer with an overwhelming caseload, then you will get lost in the shuffle and have to deal with red tape, secretaries, and paralegals. You can get a good feel of what it's going to be like when you call a Arizona Workers' Compensation attorney for the free consultation.

Myth: Any lawyer will do. A lawyer's a lawyer, right?

Fact: In reality, you need an experienced lawyer who specializes in Arizona Workers' Compensation law. Only then will you have the best odds of being awarded benefits. Think about it. You wouldn't hire a dermatologist to do heart surgery, right? Sure they're doctors-but you need a heart specialist. Now, apply that logic to picking a suitable attorney. So no, a lawyer's not a lawyer in this case.

Myth: Time is on your side.

Fact: The sand is slipping quickly to the bottom of the hourglass. You need to move quickly. First you need to get to a doctor immediately. Get an official diagnosis from your own chosen physician. Then talk to an Arizona Workers' Compensation attorney fast. Present all the information surrounding your work related injury to them. Remember-leave nothing out. Tell them everything from beginning to end.

Arizona Workers' Compensation lawyers can help you if you've been hurt on the job. So find one immediately.

Rights Involved In Workers Compensation

It is hard to imagine your life being any different than it is today. Today you can walk, bend, grab things with both hands and jump up and down if you want. The problem comes when you walk into work one day able to function normally but then an accident at work happens and bam life is never the same again. Who helps pay the bills? What happens to your livelihood?

It is never easy to think about a future that is not perfect. However this happens more often than we like to think. If you are ever involved in an accident at work however minor report it. It is important not to dismiss anything this will make a later dispute much more difficult. Reporting the accident is the very first step in making sure that while you are disabled your bills can stay on track. In fact it is very important to give details to your employer. To the medical center that treats your accident. It is important that you give details about specifically when the accident happened, where it happened within the facility and how the injury happened. It is also important to document who was around at the time of the accident. If possible get written statements from anyone who was involved or saw the occurrence.

There are some important questions that everyone who is injured on the job need answers to. In dealing with workers compensation one of the first is when will I begin to receive checks? This varies but if all the paperwork has been filled out correctly, the claim is legitimate and has been processed correctly the checks should start coming within a few weeks of the accident. The insurance company will have to investigate and record a statement and get the preliminary medical details from the clinic.

Your checks will continue until you are able to go back to work making the same amount of money you were or the case is settled. If a case is denied you will not start receiving checks at all and should contact a lawyer. Basically if this is to happen then the insurance company is claiming they are not responsible to cover the medical bills or you. This is all very time sensitive in nature and is best handed over to an attorney who will correctly navigate through the workers compensation process.

Another thing people often worry about is if their job will still be available for them when they are finally able to return to work. Your employer is required to keep the position open for twelve weeks. This is thanks to the Family Medical Leave Act. After twelve weeks they do not have to hold the position any longer.

If an employee returns to work and is placed on restriction and then fired it is thought to be because of the injury. It is up to the employer to prove that the firing was not illegal. That there was reason that you be let go. This is almost impossible for them to do. In most cases the employer will lose.

Any and all medical treatment required because of the injury is covered under workers compensation. The same is true with any. All medication that may be needed. Many employers will have you see their doctors you must petition to see your own doctor or specialist. In case such as broken bones and serious injuries it is best to go outside the clinic recommended by the company. Your care is far more important at the time than who is going to pay for it. The main goal is to get back to one hundred percent as soon as possible.