Pay for medical expenses - Texas Workers Compensation
Can you be paid for out of pocket medical expenses for Texas workers compensation?
Yes, if you have been injured at work in Texas and are covered by workers compensation you can be paid back for medical costs that you pay for.
The insurance carrier for your claim is responsible for reimbursing you or paying you back for medical costs that you pay for yourself. This can include but is not limited to the following:
- medication, prescribed or over the counter
- bandages, assistive devices or other aids
- hospital fees
- travel reimbursement
From the guidebook...
What documentation do I need?
Generally speaking a copy of the receipt, make a copy and always keep the original. Submit your request for reimbursement to your insurance carrier. Learn more about what to do first if you have been hurt at work.
What types of travel are covered?
If you are submitting a request for travel expenses you will need to complete a TDI DWC-048 "request to get reimbursed for travel costs."
Generally speaking you must travel over 30 miles to qualify for reimbursement. You are able to be reimbursed for things such as traveling for designated doctors exams, rehabilitation, treatment or to attend a contested case hearing. Items that may be covered include gasoline, food, hotels and a per mile surcharge. The amount paid is often set by the Texas Department of Insurance on a "reimbursement table".
How long do I have to get paid back?
Under Texas workers compensation law you have one year or 365 days to request reimbursement.
Do not wait this long if possible, always submit as soon as possible. If you have reoccurring expenses, make a habit to submit everything monthly.
What if my request for medical expenses was denied?
Your insurance carrier has 45 days to respond to your request for payment of out of pocket medical expenses. If they ignore your request or deny it and you feel it is valid, next file a complaint with the Texas Department of Insurance.
It may require that you request a benefit review conference to review your medical expenses with your insurance carrier. If you cannot resolve the issue at the benefit review conference your case may then proceed to a contested case hearing for appeal. You may then appeal to an administrative law judge with the Texas State Office of Administrative Hearings for a final appeal.
Purchase the guidebook, Injured on the Job -Texas today for more information on how to navigate the Texas workers compensation system. Including information on medical care, pay & wages, treating doctors and how long you can receive benefits.
