How Can Repealing Obamacare Affect Workers’ Compensation Premiums?

The future of Obamacare has been in question for quite a while. Americans are unsure of the direction it will go since it has become clear that the plan may be repealed or modified. The political wrangling has caused many to fear the ramifications of any changes that may take place. Obamacare has its share of flaws, but for many who could not afford health insurance, it was a tremendous help. With Obamacare, a large sector of the public received good medical care. Prior to its being enacted they had to go without medical care. They simply had no alternative.

There are many rumors that Obamacare might be repealed despite its many benefits. The biggest fear is that there might be no alternative healthcare plan implemented in place of this affordable healthcare solution.

Large businesses with 50 or more employees are still compelled to provide healthcare insurance to employees. If the Affordable Care Act is no longer an option the result can be a much higher insurance costs for businesses, individuals and families. Without decent health care coverage many employees may file workers’ compensation claims to avoid the high cost of healthcare. This will undoubtedly impact the cost of workers’ compensation insurance for many businesses. Employees will do whatever they can to take care of their medical needs. It can be very difficult to distinguish injuries from 2 separate accidents. And it is very difficult to distinguish accidents on the job as opposed to off the job.

Many with pre-existing conditions, which may no longer be covered, may move over to the workers’ compensation system to help treat their injuries and health conditions. If an employee injures an arm and doesn’t fully recover, then reinjures that same arm while at work, they will receive workers’ compensation benefits. Without affordable medical coverage many workers’ with pre-existing conditions may be forced into the workers’ compensation system. Insurance companies will most likely fight these cases, however the burden of proof falls on the employer and their insurance company to prove the injury and/or condition isn’t work related. This can only bog down the system and add significant costs for employers. For example: an employee gets into an argument at work and then collapses from a heart attack. Who’s to say the heart attack wasn’t from stress rather than a pre-existing heart condition? So, a door is opened to administration and legal costs, lost wages and lost work productivity. And the whole system suffers. All the shouting about “repeal and replace” has yet to offer specifics that would put the average American at peace with the subject of healthcare costs.

RoadCash – Frequently Asked Questions

How it Works
Once RoadCash is installed it works in the background. During the onboarding process you will enter your doctors name and address. This sets a Geo-Reminder to log the doctors’ appointment when you arrive at their listed address. No buttons to press to start or stop. Your reimbursement is automatically logged and recorded creating a complete record of all your different reimbursable appointments. Simply submit your reimbursement at the click of a button. Then sit back, relax and wait for your check to arrive. It’s that simple!

Travel by Car
Travel by car is reimbursable on a per mile basis. The NY mileage rate follows the IRS mileage rate, which changes generally once per year and is based on oil prices. The rate for mileage reimbursement is set by the Chair of the New York State Workers’. The mileage rate for 2017 is $00.535 per mile. We provided a complete list of the prevailing mileage rates for each year below.

Travel by Taxi
Travel by taxi may be reimbursed if the injured worker has a receipt and letter of medical necessity from their doctor. If the injured worker doesn’t have a letter of medical necessity or receipt they can claim to be reimbursed per mile. This is the same manner an injured worker would be reimbursed if travel is by car.

***A Letter of Medical Necessity can be issued by a doctor to an injured worker after surgery, or in any special circumstance in which the injured workers’ medical conditions warrants the use of a taxi.

Travel by Subway
Travel by subway is reimbursed per fee ($2.75) each way. Round Trip Total = $5.50

Travel by Bus
Travel by bus is reimbursable as per the value listed on the receipt. Reimbursement by bus is not yet available through RoadCash.

What M&T expenses are NOT eligible for reimbursement?

Round trip mileage to hearings.
Round trip mileage to the pharmacy.
Round trip mileage to your attorney’s office.
Round trip mileage for out of state medical treatment not previously approved.
Round trip mileage to vocational rehabilitation programs.
Doctor appointments which do NOT have corresponding medical reports to show proof of attendance.
Any doctors’ appointment in which the corresponding medical bill has been denied by the carrier.
What is reimbursable?
Round trip mileage for medical treatment and evaluation. This includes trips to hospitals, doctors, physical therapists, chiropractors, trips for medical tests (such as MRIs and x-rays) and trips to the insurance company’s doctor, also known as an Independent Medical Exam (IME).

How long does it take to get reimbursement?
The Transportation Reimbursement should be treated as a medical bill, therefore allowing insurance carriers 45 days for payment. Under WCL Section 54-B Judgments, the transportation reimbursement can be authorized by the Workers Compensation Board if not timely paid. If you have not been reimbursed after 45 days, you can file a RFA-1 Form requesting a hearing. Or simply contact an attorney by going to the “My Account” tab. RoadCash will connect you with an attorney for free!

Is there a penalty for not being reimbursed timely?
Yes, after filing a RFA-1 form you may go to a hearing. Don’t worry RoadCash has got your back. Just bring your RoadCash mileage log to the hearing and you will have all the information you need. If your doctor hasn’t submitted your medical bills to your insurance carrier, you will also want to get a printout of your appointments from your doctor’s office. After the hearing, if still not reimbursed by the carrier, the judge may issue the carrier to pay the transportation reimbursement and an additional $50 penalty.

When should I submit my M&T for reimbursement?
There is no deadline or time requirement to submit your reimbursement requests. You may submit such requests at any intervals that are convenient for you (such as monthly, quarterly, yearly or at the end of the case). In our experience, it is better to submit these requests every 2-3 months. RoadCash doesn’t allow users to submit their reimbursement until at least 1 month after their appointment. The 1-month lag allows time for your doctor to submit the medical bill and report to your insurance carrier.

Who do I submit my M&T requests to?
A copy of all transportation reimbursement requests go directly to the carrier, the Workers Compensation Board, the attorney (if applicable), and the user (you!). RoadCash is the easiest way to keep track of all reimbursement requests for your records. The user must include each parties email address, except for the Workers’ Compensation Board, to ensure proper submission.

Case Study: Derek Kaplan
Injured worker, Derek Kaplan, has suffered a sprain to his arm while lifting boxes. Derek’s doctors have wisely prescribed him with physical therapy, to be completed 3 times a week for an 8-week period. Derek lives 10 miles from his physical therapist and drives a car to his appointments.

2017 Mileage Rate: $00.535

Round-trip mileage for physical therapy: 10 (miles) x 2 (round trip) = 20 miles

Total Reimbursement per Visit: 20 miles’ x $00.535 (mileage rate) = $10.70

Total Reimbursement per Week: $10.70 x 3 visits = $32.10

Total Reimbursement After 8-weeks of Physical Therapy: $32.10 x 8 = $256.80

In Derek Kaplan’s case, 2 months of physical therapy (totaling 480 medical miles traveled) could mean a reimbursement of over $250!

12 Ways to Maximize Workers’ Compensation Benefits

It’s easy to get overwhelmed when you get injured. The pressing need is your recovery, but without the right action you may not get the settlement you have coming to you or you might get much less than you should. As with any insurance claim, workers’ compensation has its do’s and don’ts. Getting to your doctor’s appointments, filling out painstaking paperwork, and dealing with robotic case managers all become part of an injured workers’ life. This experience presents many challenges to those unaware of their rights and benefits. These are the twelve tips for people dealing with workers’ compensation.

1. Don’t pay for your medical bills out of pocket.
If you haven’t spoken with your case manager or an attorney, you may not know that your medical bills are covered under workers’ compensation law. If you pay out of pocket for your medical bills, you are entitled to reimbursement by your insurance carrier. However, you will likely be reimbursed according to a State Fee Schedule. The amounts for treatment in the fee schedule can be far less than what the doctor charged you.

2. Even non-prescription medications are reimbursable.
Many injured workers are paying for their over-the-counter medications such as scar ointment or topical pain relievers. If you obtain a letter from your doctor stating these items are medically necessary, you should be able to receive reimbursement from your insurance carrier.

3. Mental health is as important as your physical health.
After being injured on the job you may not enjoy the same quality of life you had before. This can be very difficult for injured workers, especially those with severe injuries. Often this leads to depression or other mental illnesses. You should have a psychological evaluation if you feel symptoms of depression, anxiety or extreme stress. If you are the victim of assault, you should be assessed for any signs of PTSD. Psychological injuries can be life threatening and should be included in the calculation of your settlement. These issues come under the category of “pain and suffering.”

4. Schedule Loss of Use Award!
If you are hurt and working on getting better, you should take the time you need to fully recover. However, if you injure body parts listed on your Schedule Loss of Use (SLU), you may be entitled to an SLU Award. When calculating the SLU Award the money you were already paid is subtracted from the settlement. Example: Chris is out-of-work for 12 weeks before returning, during which time he collects $10,000. A year after Chris had his accident it is determined he is entitled to an SLU Award of $30,000. Since Chris already collected $10,000 in compensation his SLU Award will now be worth $20,000.

• You are entitled to an SLU Award if you injure your hands, fingers, feet, toes, arms, shoulders, hips, legs and for facial disfigurements. If you injure an SLU body part, always ask your doctor for an SLU report

5. Use available apps to save time and make your life easier.
According to surveys approximately 75% of injured workers don’t know they are entitled to reimbursement for transportation expenses. You are entitled to reimbursement for travel to your doctor’s office, Independent Medical Exams (IMEs), diagnostic testing and various other trips relating to your workers’ compensation case. The easiest way to collect your travel reimbursement is through the RoadCash app. RoadCash is a mileage-logging app specifically created for those receiving workers’ compensation benefits.

6. Know that you CAN get a settlement.
You can almost always receive a settlement, but only if you ask. Many times, if you don’t have an attorney, the insurance company will try to retire your case without even mentioning a settlement. You need to be aware of this because your settlement can be substantial.

7. Get a second opinion!
Part of maximizing your benefits is ensuring you are getting the correct treatment for your injury. If you aren’t getting better, or just don’t feel you are getting the treatment you deserve, you should speak with another doctor.

ALWAYS get a second opinion before going for surgery.

8. Make sure you go to a licensed workers’ comp doctor.
Many states require doctors to obtain a special license to treat injured workers receiving workers’ compensation benefits. If you go to a doctor that isn’t licensed, you will be stuck paying your own medical bills. Ask the question when making an appointment. Is Dr.X licensed to treat workers’ compensation cases?

9. Hire an attorney.
Hiring an attorney is a personal choice when you have a workers’ compensation case. Attorneys will make sure you are receiving the proper benefits and will allow you to receive the highest settlement possible. They don’t work for free, so be sure to get an idea of what the cost will be.

10. Providing your tax returns to ensure you establish the correct average weekly wage (AWW).
Many times, the insurance company will use the Average Weekly Wage provided by your employer, which may be lower than your actual AWW. By submitting your tax returns you can prove your actual earnings and have your AWW increased by the Workers’ Compensation Board. If you receive tips or other benefits they should be included in your AWW as well.

11. Be nice to your case manager.
Case managers in the insurance industry have a bad reputation. They have a lot of responsibility and they get stressed out just like everyone else. If you want to get the best help—treat them with respect and be polite. It is well worth it because they have a lot of control as to how things work out for you. Being nice to your case manager can help expedite requests for treatment and increase the likelihood of them providing you with useful information.

12. Be aware of investigators.
Getting caught can cost you your settlement and could lead to being charged with fraud. Check out the video below of a lady on workers’ comp who claimed to be “Totally Disabled.” The action on the TV show “The Price is Right” would indicate otherwise.