WHAT HAPPENS IF I AM INJURED AT WORK BUT MEDICARE OR HEALTH INSURANCE PAYS A BILL

Under the Illinois Workers’ Compensation Act, if you are injured on the job your employer is required to pay related medical bills. According to section 8(a) of the Act, the employer has to pay the lesser of the healthcare providers actual charges or the amount set out in the Worker’s Compensation fee schedule in effect at the time the medical care was provided. If you seek medical care for a work-related injury, tell your health care provider that your injury should be covered by Workers’ Compensation.

When you go to see a health care provider for a work injury, make sure you give them the workers’ compensation information and your health insurance information. Your employer may agree that your injury is covered by the Workers’ Compensation Act and pay those medical bills directly. On the other hand, if the employer denies that your injury arose out of and in the course of employment, the health care provider will be able to bill your health insurer, including Medicare.

In that case, if you and your lawyer prove that your injury arose out of and in the course of your employment, the workers’ compensation insurance company has to reimburse any health insurance plan provided by the employer. If your health insurance is provided by someone other than your employer, the workers’ compensation insurance company can work with you and your lawyer to make sure your bills are paid and the health insurance company gets appropriately reimbursed.

Finally, if you are a Medicare recipient, the workers’ compensation insurance company is obligated, under Federal Law, to reimburse any and all related payments made by Medicare.