How Does Workers Compensation Interact With Medicare?

If you've suffered a workplace injury or accident, you're probably focused on filing for workers compensation to help pay your medical bills and other related expenses. But what if Medicare is your primary insurer? Can you still receive workers compensation -- and will you be able to afford all your bills? Read on to learn more about how your workers compensation payments may interact with your Medicare benefits.

What type of workers compensation benefits will you receive?

Because workers compensation benefits are administered by the state, the amount of compensation can vary -- any variance will depend not only on the severity of your injury, but on your pre-injury salary and your state's available benefits.

  • Medical payments

One common thread across all state workers compensation programs is the payment of any and all medical expenses stemming from your workplace accident. Although pre-existing conditions that are aggravated by the accident may be a point of contention for your employer's insurance company, you should expect to (eventually) have all medical bills associated with your accident covered.

  • Lost wages

Most states will pay a certain percentage of your pre-injury salary if you're forced to take off uncompensated time as a result of your injury. However, these benefits last for only a limited time -- if you are facing a long-term disability, you may be required to file for Social Security disability after your workers compensation payments cease.

  • Supplemental benefits

In some states, you may be able to recover additional benefits if you are able to return to work, but are not able to earn the same wages as you did prior to your accident. However, it is unlikely that these supplemental benefits will completely make you whole -- that is, bring you to the salary you were earning previously.

Will Medicare help pay your bills while your workers compensation claim is pending?

If you have Medicare coverage, you shouldn't worry about paying any medical bills that have resulted from your workplace injury. In some cases, your workers compensation benefits may be speedy (or your medical bills slow) enough that everything is covered before you even receive a bill.

In other cases, you may start getting medical bills while your workers compensation claim is still pending. If this happens, Medicare may make temporary payments on these bills so that your accounts stay current -- once your workers compensation claim is approved, your employer's insurance company will reimburse Medicaid directly for any medical payments.

If you suffered from a pre-existing condition prior to your injury, you may find yourself in a situation in which Medicare pays the bills associated with your initial problem, while workers compensation covers those that have resulted from your injury. Although Medicaid and your employer's insurer may battle it out over responsibility and reimbursement, at no point should you be personally responsible for any bills. If you are having trouble collecting your needed funds, contact an attorney like those at Hooton, Wold & Okrent LLP.