Future Benefits for Oklahoma Workers' Compensation

When someone is injured while on the job, he or she may be eligible for workers’ compensation benefits. If this turns out to be the case, then the injured worker will be able to collect weekly benefits payments from Oklahoma’s workers’ compensation insurance fund and will also be able to receive the medical care necessary to be rehabilitated as much as possible.

However, there are some situations in which the injured worker will not only need medical care in the present, but will also need it in the future and for an undetermined amount of time. This is when the question of future medical benefits within the realm of workers’ compensation law arises in Oklahoma. Below is an overview of this issue.

Standards that Apply

Future medical benefits must fall under a basic standard in order to be paid for by the employer. This standard is that the medical care must be ‘reasonable and necessary’ in terms of how long the care will last, the type of care that will be provided and the types of specialists and rehabilitation that will be needed. As such there is no hard-limit duration after which the future medical benefits will expire.

Why You Need A Workers' Comp Lawyer

However, every injured employee in Oklahoma needs to be aware that future medical benefits are an item that can be bargained for with your employer, and that also means that they can be bargained away if you receive some sort of offer in exchange for a ‘release’ or a ‘waiver of future liability.’ Be wary of any document that’s presented to you in the manner and contact an attorney before affixing your signature.

Statutory Language

The Oklahoma legislature has passed a series of statutes that govern this situation and the procedures behind it. Many of the controversies that arise within this context involve payment for services between the employer and the insurance carrier. Below are selected passages from relevant statutes:

A. General: Disputes regarding payment for health or rehabilitation services rendered pursuant to the Workers' Compensation Act may be addressed as set out in this rule. A Form 18 proceeding is an administrative review of disputed medical charges. A Form 19 proceeding may involve judicial resolution of disputed charges for health services. Mediation refers to a process of resolving disputes with the assistance of a mediator outside of a formal court proceeding.

D. Form 18 Proceedings:

1. Disputes arising after a medical charge has been paid, involving conflicting interpretations of the Schedule of Medical and Hospital Fees may be addressed by filing a Form 18, as provided in Court Administrator Rule 1.

2. Either party aggrieved by the Administrator's order directing or denying the payment of medical charges may appeal such order to a judge of the Workers' Compensation Court by filing a Form 19 and a Form 9 within ten (10) days after the Administrator's order is entered. The Form 19 must be appropriately marked to indicate that it is being used to appeal the Administrator's order. The following shall be attached to the Form 9 when filed:

• A copy of the administrative order appealed from;
• Copies of all materials submitted to the Administrator in the administrative review proceedings;
• A statement identifying each portion of the Administrator's order claimed to be in error; and
• An explanation of how each portion of the Administrator's order urged in error conflicts with the Schedule of Medical and Hospital Fees.
• The appealing party must mail a copy of all materials which are filed in the appeal to each opposing party. No response to the appeal of the Administrator's order is required.

• Form 19 Proceedings:

1. A rehabilitation provider, case manager or a medical provider may institute proceedings to recover charges rendered for rehabilitation or health services, medicines or supplies which have been provided to a claimant, by the filing of a Form 19, Part I, if the provider has not received payment within sixty (60) days from the date the charges were submitted to the uninsured or own risk employer or insurance carrier. A Form 19 may also be filed if the uninsured or own risk employer or insurance carrier has refused liability for the payment of the charges on one or more of the following grounds:

a. Length of treatment;

b. Necessity of treatment;

c. Unauthorized physician;

d. Denial of compensability of the claimant's accidental injury or occupational disease; or

e. Any other objection requiring a judicial determination for resolution.

How this Affects the Injured Worker

What this all means is that the injured worker could wind up being responsible for the medical bills if he or she is not careful about protecting his or her rights to those benefits. If this has happened to you, or could happen to you, contact the Oklahoma workers’ compensation attorneys at Atkins & Markoff immediately to schedule an initial consultation.