What is workers’ compensation?
Workers’ compensation benefits
Workers’ compensation claims process
Do I need an attorney? Common situations
How is a WC settlement determined?
Other topics
There are times when an injured worker is also covered by Medicaid for their health insurance needs. As a result of this circumstance, there are times when an injured workers' physician inadvertently bills treatment or services under the injured workers' Medicaid coverage instead of their workers' compensation coverage. This becomes an issue if the workers' compensation claim is subsequently settled.
Therefore, your workers compensation attorney must take steps to contact Medicaid, prior to settling, in order to determine if there are any bills for which Medicaid will request reimbursement. This is due to the fact that the bill should have been paid by the Ohio Bureau of Workers' Compensation, or your self-insured employer. Medicaid provides a process in which any claim for reimbursement made on their behalf can be contested. Once the injured worker, or his attorney, is notified of any services that were paid by Medicaid, he must then provide proof to Medicaid that the bills were not related to the claimant’s treatment under his workers compensation claim. Generally, unless the bill was clearly related to treatment of an allowed condition in the workers' compensation claim, Medicaid will withdraw the request for reimbursement. However, if the proper steps to appeal these bills are not taken, Medicaid will demand reimbursement upon the settlement of the claim.
Our office does not allow the above situation to occur. How do we do this? By taking the appropriate steps to appeal these determinations and explain to Medicaid why the bills are not related to the work injury. There are times in which the bills are clearly related to the injury, and in these cases the injured worker is notified by our office ahead of time in order to determine if they want to go forward with the settlement and have our office deduct the amount owed from their portion of the settlement for the reimbursement to Medicaid. Also, we will give the claimant the time to determine if they want to cancel the settlement, in order to prevent the payment of their settlement funds to Medicaid, and instead continue forward with the workers' compensation claim allowing it to remain open. Medicaid only makes demands for reimbursement if they are notified that the claim has been settled.
If you have a situation in which you are on Medicaid and are thinking of settling your claim, you should discuss this matter with your attorney. Please note our office is well aware of the situation and, if you need assistance, please contact us at your convenience.
