What Happens to Medical Bills When Workers’ Comp Is Denied?

By Kasey Murray

More than 2.8 million Americans sustained a work-related injury or illness in 2022. Washington, D.C., area employers must provide workers’ compensation coverage to protect workers. However, employers or their insurance companies sometimes refuse to pay claims, leaving injured workers scrambling to pay the bills. What happens to medical bills when workers’ comp is denied?

What To Do About Your Medical Bills If Workers’ Comp Is Denied

what happens to medical bills when workers' comp is denied

If your workers’ comp claim is denied, you still have options. You can appeal your claim through the insurer if your employer’s workers’ compensation insurer offers an appeals process.

If the insurer denies your appeal or doesn’t have an appeals process, you can appeal your claim through the Workers’ Compensation Commission in Maryland or Virginia or the Department of Employment Services in D.C.

However, proving the insurance company denied your claim without a valid reason can be difficult. A workers’ compensation attorney can help you file your appeal and present a strong case at your hearing. 

How the Workers’ Comp Appeals Process Works

In Washington, D.C., the appeals process for a workers’ compensation claim denial begins with an investigation by the Department of Employment Services Office of Workers’ Compensation. The OWC may attempt to resolve the dispute through an informal conference.

If you cannot reach an agreement, you will have 14 working days to notify the OWC in writing and 34 working days to file for a formal hearing. Should the Administrative Law Judge deny your appeal, you will have 30 days to file an Application For Review with the Compensation Review Board.

If you still have a dispute after the AFR decision, you have 30 days to appeal the Decision and Order to the D.C. Court of Appeals. You will not receive any benefits during the appeals process. However, if you win your appeal, your employer or the insurance company must pay your claim.

The appeals process in Maryland and Virginia is similar but has some procedural differences. An experienced workers’ compensation attorney can help you properly file your appeal.

How To Pay Your Medical Bills During or After the Appeals Process

Talk to your health care provider if you need help paying your bill.

Your healthcare provider may agree to wait for payment until you receive a decision on your appeal. Your provider may also place a lien on your workers’ comp claim to ensure it receives compensation if you win your appeal.

If you lose your appeal or your medical provider expects immediate payment, you may be able to use your health insurance to cover your bills. Your insurance provider may seek recovery from the workers’ compensation insurer through the subrogation process or require you to reimburse the insurer if you receive a workers’ compensation settlement.

If you lack health insurance and meet the requirements, Medicaid or Medicare may cover your medical expenses. 

Help With Medical Bills When a Workers’ Comp Is Denied

If you have unpaid medical bills because your workers’ comp is denied, the attorneys at Koonz, McKenney, Johnson & DePaolis, LLP can help. Contact us today to schedule a free consultation. We will never charge you a fee unless you receive compensation.

About the Author
Washington, D.C. and Maryland injury lawyer Kasey K. Murray represents clients in a wide range of personal injury areas including car accidents, premises liability, construction accidents, medical malpractice, workers compensation claims and various appellate matters.