Money isn’t everything – Don’t let your insurer short your medical bills

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One of the most common reasons injured workers contact me is because their doctor is asking for specific treatment and the self-insured employer refuses to pay. Obviously if the treatment is for a non-industrially-related condition, this would make sense. Sadly, these self-insurers play games and offer faulty excuses to get out of paying for the treatment of related conditions as well; a rather deceitful attempt to wiggle out of the deal struck in 1911 between legislators, businesses and labor leaders, most of whom represented the mammoth lumber industry which employed three-quarters of Washington’s workers at the turn of the 20th century.

History class aside, the purpose of the Industrial Insurance Act was and is to provide “sure and certain relief for workers, injured in their work…” To that end, the legislature has created a penalties provision to hold self-insured employers accountable for making timely payments of monetary benefits including time-loss payments and permanent partial disability awards. Unfortunately, this legislative protection has only been offered for monetary benefits and not medical or vocational benefits.

Thankfully the Board of Industrial Insurance Appeals, or BIIA, has recently addressed this issue. In the 2012 BIIA decision, In Re: Coston, the term “benefit” was broadened to include both monetary and medical benefits as well.

This is a fantastic tool which all injured worker representatives should be using to stop self-insured employers from delaying or refusing to pay for necessary treatment for industrially-related injuries and conditions.

If you have a question about benefits, need to protest a decision or you’re unsure about the next steps in your claim, call us at (509) 228-7011 or use our contact form  to set up a free consultation.

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