A worry that afflicts many Ohio workers who suffer workplace injuries and are awaiting workers’ compensation benefits is: what happens if there are out-of-pocket costs that they must pay for? Given the expensive nature of medical treatment, prescriptions, rehabilitative care and more, these expenses can be substantial. Knowing the law for claimant reimbursement is critical.
A claimant or anyone who makes payments for the claimant can be reimbursed if the workers’ compensation claim is approved and evidence of the payment having been received is provided. This applies to medical services or supplies. There are exceptions to this rule in which the payor will receive only what would have been paid based on the law for claimant reimbursement.
In the event the payor is the claimant’s insurance provider, the claimant might want to be reimbursed for a co-payment. This can be paid, and the insurer can be reimbursed up to the amount that would have been paid if it meets the rules of this law. For claimants who have paid out of pocket for outpatient medication from a pharmacy because it is not payable unless it followed the administrative code, it can be signed by an officer who is authorized to do so. The medication might later be payable. If so, the out-of-pocket payment might be reimbursed.
For payments that were already made to the health care provider, the payor will be informed to seek reimbursement from the provider. There are timeframes for reimbursement that the employee must be aware of. Out-of-pocket costs can accrue to large sums. Medications that are necessary for the worker to recover could also be costly. For those who have made these payments, received assistance to make these payments, or made co-payments through their own insurance, it is possible to be reimbursed. Having legal assistance with understanding any issue related to workers’ compensation can be critical to receive the maximum amount of benefits.
Source: bwc.ohio.gov, “4123-6-26 Claimant reimbursement.,” accessed on April 3, 2018