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Jackson & New Orleans Workers' Compensation / Mississippi Medical Benefits, Treatment and Guidelines

Workers’ Comp Medical Benefits, Treatment, and Guidelines in Mississippi

Workers’ compensation laws are considered a no-fault system, meaning that injured workers have a right to file a claim and receive medical benefits without the need to prove fault. If you’ve been injured on the job, you have a right to claim workers’ compensation benefits to help cover all necessary medical expenses relating to the incident.

Unfortunately, insurance companies and even employers will sometimes look for ways to deny a claim or, at the very least, reduce the amount owed, to avoid having to pay so much money every time an employee is injured. Due to these backhanded attempts, it is often necessary to work with an experienced attorney to ensure that you receive the full amount of medical benefits that you deserve.

The Mississippi workers’ compensation lawyers at Lunsford, Baskin & Priebe, PLLC help injured workers get the benefits they are entitled to after an on-the-job injury. Our lawyers represent ironworkers, construction workers, truck drivers, general laborers, firefighters, and first responders injured on the job. Learn more about Mississippi workers’ compensation below, and contact Lunsford, Baskin & Priebe, PLLC if you’ve been injured in a workplace accident.

Who is Eligible for Workers’ Comp Medical Benefits?

In all states, most employees have a right to workers’ compensation medical benefits. However, the exact laws can vary from state to state.

In Mississippi:

Employers with five or more employees in the state of Mississippi must have workers’ compensation coverage. If they have fewer than five, they may still provide coverage voluntarily, but it is not required. Mississippi does not require a minimum salary for workers to be eligible for benefits. They do have certain types of workers that are not eligible. Such employees include:

  • Independent contractors
  • Farm laborers
  • Non-profit employees
  • Domestic laborers
  • Employees of religious organizations
  • Cultural organization employees

Additionally, transportation workers, maritime workers, and federal employees are not eligible for state compensation benefits as they have their own private workers’ comp systems.

What Medical Benefits Are Available Through Workers’ Compensation in Mississippi?

There are two main types of benefits available through workers’ compensation: medical and wage replacement benefits. For the purpose of this page, we’ll be discussing the specifics of the medical benefits. The medical benefits portion of a workers’ comp claim is there to help you pay for all reasonable and necessary medical treatments relating to a workplace injury or illness.

However, it is not uncommon for employers or their insurance companies to fight back against a claim. Though you have a right to workers’ comp benefits and do not need to prove fault to receive them, your employer or the insurance company may use tactics to reduce benefit amounts. For this reason, it’s important to fully understand your rights relating to the medical benefits, treatments, and guidelines. Often, it is necessary to work with an experienced workers’ comp attorney as they can guide you through the process to ensure you receive everything you are owed.

What Are the Medical Benefits?

In Mississippi, workers that have been injured on the job or suffered a work-related illness are entitled to have all of their accident-related medical bills paid for. The medical bills and expenses that you can receive compensation for include:

  • Doctors visits
  • Diagnostic testing (i.e., X-rays, MRIs, CT scans, etc.)
  • Other medical testing
  • Bloodwork and lab testing
  • Prescription medications
  • Medical supplies needed to care for the injury or illness
  • Hospital stays
  • Medical treatments
  • Surgeries
  • Rehabilitation services
  • Physical Therapy
  • Prosthetics
  • Other medical or non-medical treatments recommended by your physician that are recognized by state laws as legal and relating to the injury (this can include alternative treatments, chiropractic care, massage therapy, etc.)
  • Travel expenses for driving/commuting to obtain medical treatments and services

What Types of Accidents and Injuries Are Covered?

Mississippi compensation benefits cover any injury or illnesses that results from work done on the job. This includes all work-related occupational illnesses and diseases, as opposed to only traumatic accidents such as ladder falls or machinery malfunctions. A work-related death is also compensable with workers’ comp benefits. At Lunsford, Baskin & Priebe, PLLC, Mississippi workers’ compensation lawyers handle a variety of different types of claims for injured workers. While any number of illnesses and injuries can result from work-related incidents, some of the more common ones we see include:

  • Back injuries
  • Neck injuries
  • Spinal cord injuries
  • Fractures
  • Shoulder injuries
  • Knee injuries
  • First responder illnesses, such as cancer or heart and lung diseases

Most work-related injuries or illnesses are obviously a result of work performed while on the job, but this is one of the main areas that workers’ comp insurers will try to dispute. This is why it is extremely beneficial to work with a workers’ comp attorney. We know the ways that insurers will try to get out of paying benefits and can help guide you through the process to ensure you are awarded the full amount of benefits that you deserve.

Seeking Treatment and Emergency Medical Care

It is your right as an injured worker to seek immediate medical attention for your injuries or illness. You should never wait to be treated, as delaying your medical care can be detrimental to your health and negatively impact your claim. If your employer refuses to arrange medical care for you, you may have to pay for initial care upfront, but the insurance company will later be required to reimburse the expenses.

Generally, workers are required to receive approval from the workers’ comp insurance company before they visit any new providers. However, no approval is necessary if a doctor from the ER verifies that the worker had a genuine medical emergency.

It’s important to note that your employer’s insurance company may compel you to seek treatment with a specific doctor, but it is your right to choose your own physician. Often, employers or insurance companies will choose a doctor that they know is on their side, but as the one who is injured, you have a right to choose a doctor that you feel will have your best interest in mind.

The doctor your employer’s insurance company chooses will then serve as a “second opinion” should there be any disagreements about what treatments are deemed necessary. In situations with differences of opinion, it may even be necessary to seek an Independent Medical Exam (IME) with a doctor chosen by your state workers’ compensation division or the court.

Why Choice of Physician is Important

Choosing the primary treating physician for your case is critical. Not only will they be responsible for determining the extent of your injuries and treatments necessary, but they will also decide when it is safe for you to return to work.

You should never choose the insurance company’s choice of doctor as the primary treating physician. This is because they will likely try to downplay your injuries and symptoms to reduce the benefit amount and get you back to work as quickly as possible without your best interest in mind.

If you are ever unsure about what decision to make, you can always consult your attorney. It is their job to fight for you and your best interests, not your employer’s. They can offer you tips and guidance to ensure you receive the best medical care possible and receive the best possible outcome for your workers’ comp case.

Medical-Related Decisions Out of Your Control

While you have the right to choose your own doctor, some decisions will typically be left to the insurance company. These include:

  • The pharmacy that will provide the prescribed medications
  • The facility or lab that will perform diagnostic testing
  • Additional referrals to specialists or other physicians (you are allowed an initial physician of your choosing and one referral to a specialist, but the insurance company must approve any additional referrals)
  • Who will act as your nurse care manager if one is needed

Payment Timeline and Guidelines for Medical Expenses

The workers’ compensation insurance company should provide you with documentation of the state guidelines for “all necessary drugs, supplies, hospital care and services, medical and surgical treatment, and any non-medical treatments” that are related to the injury or illness. This will give you an overall understanding of what you can seek treatment for and what is covered.

However, as mentioned earlier, initial approval from the insurance company is required before you seek treatment beyond $750 unless the treatment is provided in an emergency situation in an ER.

All medical bills and expenses that fall within the guidelines and are approved must be paid to you by the insurance company within 60 days. If the bill is sent electronically, however, payment must be provided within 30 days. Any bills or receipts you receive for your medical expenses relating to the workplace accident should thus be sent as soon as possible to your employer or the insurance company.

Timeline on Benefits

After the initial accident and injury or illness is sustained, the worker has one year from the date of the incident to file their workers’ comp claim. If they fail to do so, they will lose their right to medical benefits. If an initial claim was filed and benefits were received, the injured worker has three years from the date of the last medical benefit payment to file a claim for further benefits.

Filing a Mississippi Workers’ Compensation Claim for Medical Benefits

To ensure that you fulfill all requirements necessary to have your workers’ compensation medical benefits approved, be sure to follow these steps:

  1. Notify Employer: After any workplace accident or injury, or if you have been diagnosed with an occupational disease, you should notify your employer as soon as possible. This notification will likely either be to your supervisor or to a person designated by the company to receive workers’ compensation notices. Mississippi requires that you report the accident within 30 days, but the sooner you notify your boss, the sooner the claims process will get rolling.
  2. Employer Files Claim: Once the employer is notified, the state and the company’s insurance carrier will be notified. In Mississippi, the employer files with the Workers’ Compensation Commission (WCC) in Jackson and also notifies its workers’ comp carrier.
  3. Appeal to Agency: In the best-case scenario, you will soon start to receive wage replacement benefits, and the insurer will cover your medical bills. If there is a dispute and benefits are not being paid, you may need to file a claim with the WCC or Workforce Commission. In Mississippi, you have two years from the injury to file a claim with the WCC to appeal a denial by the insurer. This process is started by filing a petition to controvert.
  4. Appeal to Court: Filing an appeal will lead to a hearing before an administrative law judge. In Mississippi, you can appeal the judge’s order by appealing to the Full Commission within 20 days. The Full Commission may review records filed by the parties, or it may hold another hearing. If dissatisfied with the Full Commission result, you have 30 days to appeal to Circuit Court or the Mississippi Supreme Court if you choose.

The further you go in the workers’ compensation process, the more technical and complicated the steps become, and the more critical it is to have an experienced workers’ comp lawyer representing you. Retaining a lawyer sooner may help you get your benefits sooner, and it will also cost less to resolve your claim without having to go to court. Our dedicated workers’ comp lawyers can help you at any and every stage of the workers’ compensation process in Mississippi.

An Experienced Mississippi Workers’ Compensation Attorney Can Help

As an injured worker, you have a right to compensation to cover all necessary medical bills and expenses so you can focus on your health and recovery. Our professional, dedicated team has years of experience practicing exclusively in the area of workers’ compensation law. We’ll take on the task of making sure you get your medical benefits promptly and fully paid, including appealing claim denials if necessary.

For help with a Mississippi workers’ compensation claim, contact the workers’ compensation lawyers at Lunsford, Baskin & Priebe, PLLC for a free consultation.

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