The $15,000 Medical-Only Program is an ideal way to handle small workers’ compensation claims. It authorizes employers to pay up to $15,000 of medical bills when a worker sustains a minor injury and does not have to miss more than seven days of work.
Employers choose to participate in this program because it has the potential to lower costs in the long term. If your industry is one that sees its fair share of minor worker injuries, this may be a good option for you. Here are the pros cons of the $15,000 Medical-Only Program and how to stay eligible.
The primary purpose of this program is to streamline smaller claims. This prevents minor injuries from needing to be run through insurance and removes many bureaucratic barriers to workers’ medical treatment. Medical bills stay current not only because you are required to pay within 30 days but also since there are fewer steps to bill payment.
Opting into Medical-Only reduces the number of filed claims. Since you are paying the lower-cost claims, they no longer need to be submitted to your carrier. This may reduce your premiums.
Finally, by receiving these bills, you know for certain that your employee is following through with treatment. This substantially reduces the risk of fraud and maintains trust between you and the injured worker. That can increase morale since this produces a more cooperative rather than an adversarial experience. In a way, your involvement shows you care and that is often satisfying to employees.
The BWC has strict requirements for employers to remain eligible for this program. They include:
Record Keeping. You must maintain records of the injury and payments for five years after paying the final bill. If the BWC asks for proof of payment, be prepared to supply them.
Stay Current. Pay all bills within 30 days of receipt to be certain you pay in accordance with the fee schedule.
Report claims to Medicare. If Medicare is involved with medical treatment or bills, visit the Centers for Medicare and Medicaid Services website and follow instructions for reporting those claims.
It is up to you to inform employees and medical providers of your participation in this program. Provide this information on posted literature and if an employee is injured on the job, inform them that you will cover the medical bills.
Be aware that wages are not part of the $15,000 limit. That only applies to medical expenses; if your employees are entitled to paid time off, that will be in excess of this limit.
Also, any claim that goes beyond seven missed days or the $15,000 maximum must escalate. Once you reach the limit, inform the provider and BWC that your Managed Care Organization will take over processing bills and evaluate treatment progress.
Paying the bills does not grant you any decision-making power over medical treatment. You cannot deny payment because you believe the treatment is excessive or unnecessary. Also, participation also does not waive the worker’s right to file a claim. However, you can dispute that claim even if you agreed to pay the first $15,000 of medical expenses.
Dawson & Associates, LLC is a law firm for employers. We handle various types of employment cases including workers’ compensation defense, litigation, and administrative law. If you are facing challenges with your employees, contact us today to schedule a consultation.