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When does medical coverage through workers’ comp end?

On Behalf of | Aug 8, 2022 | Workers' Compensation |

Most employers in Texas make the decision to carry workers’ compensation. If your employer participates and offers coverage, you have the right to make a claim if you suffer an injury on the job. You can also receive medical benefits for health issues related to your employment, like a repetitive stress injury.

Workers’ compensation medical benefits are often a better option than private health insurance. You won’t have to pay a copay for your care, nor will you need to meet a deductible. The workers’ compensation insurance company should cover all of the costs.

However, there are certain limits that apply to medical benefits, and your rights to coverage may eventually end. When will workers’ compensation stop covering your medical care?

When you fully recover

For most workers, their right to medical benefits will end when they are able to return to work or when their symptoms disappear. Broken bones and other common injuries will eventually fully resolve, allowing a worker to return to work and ending their dependence on workers’ compensation coverage.

When you reach maximum medical improvement

If you hurt your back or develop carpal tunnel syndrome because of your employment, you may not experience a full recovery and the end of your symptoms. Instead, your condition will improve up to a certain point. After you reach that point, any future treatment will have a diminishing return on the investment made.

When the doctor overseeing your care decides that you have achieved maximum medical improvement  for your condition, that determination will affect your medical benefits. You will have to attend an evaluation, after which standard treatment benefits will end. You may still get coverage for maintenance care or even partial permanent disability benefits if you cannot do the same job you did before.

When you don’t follow medical instructions

Sometimes, a patient who still requires medical support will lose their right to workers’ compensation because they did not comply with their doctor’s instructions. If you are not compliant with the recommended care plan, you may put your future right to benefits at risk, as your employer can then claim that your failure to follow instructions contributed to your ongoing symptoms.

Workers who follow their treatment plans and communicate effectively with the doctors and insurance companies managing their care will have the best chance of making an optimal recovery. Learning more about workers’ compensation benefits can help employees who need support for a job-related medical issues.

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