“Dangers” Of Processing CTS Related Medical Bills Through Group Health Insurance

From a legal standpoint, your employer’s role in the Workers’ Compensation claim process is straight-forward and limited. Upon notification that you have been diagnosed with Carpal Tunnel Syndrome, your employer is required to:

  • Send a one page accident report form entitled Form 45 to their Workers’ Compensation insurance carrier. This will trigger the opening of your file and the processing of your benefits.
  • Provide you with the name, address and telephone number of their Workers’ Compensation insurance company.
  • Provide you with a handbook on Workers’ Compensation published by the Illinois Industrial Commission.

However, in practice, many employers will direct the worker to receive treatment under their group health insurance plan. The employer is fully aware that the injured employee should be referred to the Workers’ Compensation insurance company.

Unfortunately, by receiving treatment under the group health insurance plan, “CTS” sufferers are in effect, forfeiting their legal right to receive Workers’ Compensation benefits. Consider the following:

  • The exclusive benefit provided by these plans is the payment of medical bills. They are usually subject to deductibles and/or co-insurance payments with pre-set spending limits.
  • No group plan provides benefits for workers who lost time from work to recover from their injuries.
  • No group plan provides for the payment of partial permanent disability benefits resulting from the residual affects of “CTS”.
  • No group plan provides for vocational retraining or re-schooling if you are unable to return to your job after completing treatment for “CTS”.
  • Finally and most importantly, the majority of group health insurance plans require the employee to indicate in writing that the bills submitted for payment were not incurred as a result of a work-related injury. Such an admission could jeopardize a subsequent claim for Workers’ Compensation benefits.

The bottom line… you will be needlessly jeopardizing your financial security and forfeiting your legal right to receive Workers’ Compensation benefits by receiving treatment under the group health insurance plan.

A worker’s “Quick Guide” to the basic benefits provided by Workers’ Compensation insurance versus group health insurance
Workers’ Compensation
Rights & Benefits
Worker’s Compensation Insurance Group Health Insurance
MEDICAL EXPENSES

  • 100% of all reasonable & necessary medical expenses
  • No deductibles
  • No co-insurance payments
  • No pre-set limits
YES NO

  • Requires a deductible

  • Requires co-payment

  • Pre- determined limits on treatment

TREATMENT – CHOICE OF DOCTORSProvides treatment by a minimum of 2 doctors of your own choosing

  • Treatment can be received at any medical facility of your own choosing
YES NO

  • Must choose doctor on plan’s “list of doctors”
  • Must receive treatment at plan facilities
  • Requires approval for referral to specialist
LOST WAGE BENEFIT

  • Pays a weekly tax free benefit while you are off work recovering & under active medical treatment
  • No specified time limitation
YES NONOT PROVIDED BY ANY GROUP PLAN
LUMP SUM SETTLEMENT OR AWARD

  • Compensation for residual effects of CTS even if you return to your prior profession
  • All monetary benefits are tax-free
YES NONOT PROVIDED BY ANY GROUP PLAN

Related: