Workers comp pays for medical bills in Wisconsin under Wisconsin Statutes Sec. 102.42 “as may be reasonably required to cure and relieve from the effects of the injury” whether medical, surgical, chiropractic, psychological, podiatric, dental or hospital treatment, including treatment by physician assistants and advanced practice nurse prescribers. If the workers’ compensation insurance company denies treatment, the injured employee must prove the work-relatedness of the treatment by expert medical testimony. Wisconsin Tel. Co. v. Industrial Comm’n, 263 Wis. 380 (1953).
Workers comp may required to pay for future medical treatment, provided the judge finds it is work-related and the treatment is specifically determined to be reasonable and necessary. Expert opinions are necessary.
After the end of healing or the healing plateau, the workers comp insurance carrier is responsible for reasonable and necessary treatment “to prevent further deterioration in the condition of the employee or to maintain the existing status of such condition whether or not healing is completed.” Wis. Stat. § 102.42(1). Such liability is open for 12 years from the last payment of compensation. Liability for medical expenses generally does not cease with a final order but is subject only to the statute of limitation. Wis. Stat. Sec. 102.17(4) ; Lisney v. LIRC, 171 Wis. 2d 499 (1992) . Liability for future medical expenses can be stopped or closed by a full and final compromise approved by the department. Schenkoski v. LIRC, 203 Wis. 2d 109 (Ct. App. 1996). An employer may be liable for medical expenses incurred for a worker’s treatment for an occupational disease before the actual date of injury.
If medical expenses are paid by health insurance, which almost always has a worker’s compensation exclusion, the judge will order the worker’s comp carrier to reimburse the health insurer if liability against the worker’s compensation insurance carrier is later found. See Wis. Stat. Sec. 102.30(7)(a).
The workers comp carrier may also have to pay the health care provider the charges or portion of the bill that was written off or adjusted under the health insurance contract. Monson v. Heyde Health Sys., Inc., WC Claim No. 2005-009475 (LIRC June 18, 2008) and Pospichal v. Ashley Furniture Indus., WC Claim No. 2002-022704 (LIRC Nov. 30, 2004).
Milwaukee, Wisconsin McCormick Law Office attorneys work with the injured employee to submit any outstanding work-related medical bills and health insurance subrogation liens at the hearing. This can be a complicated process as sometimes the doctor bill states a zero balance because it is in collection or written off. Ultimately, it is the injured worker’s responsibility to let us know all work-related health care providers and provide us with current, complete and accurate billing statements.
