Determining Fault In An Accident

Injured On The Job In Delaware? Will You Be Able To See Your Regular Doctor?

If you live near the Delaware border, your primary care physician may be based in a neighboring state because of convenience, a prior move, lower cost of treatment, etc. But when you're injured at work, your workers compensation coverage may provide full medical reimbursement only for services provided in Delaware, where the policy is based. Is there anything you can do to see your own physician without paying out of pocket for a work-related injury? You can certainly talk with a workers compensation attorney for help. However, you can also read on to learn more about changes coming to the Delaware workers compensation process that may make it easier for you to seek treatment in another state. 

Why does Delaware workers compensation coverage restrict payments to non-Delaware doctors?

Like many states, Delaware requires any business with employees to pay workers compensation to the state -- a type of insurance that helps cover lost wages, employee medical expenses, and other costs incurred in association with a work-related or on-the-job injury. Because these payments are administered by the Delaware legislature, there is a vested interest in keeping these dollars within the state, allowing the legislature to limit the funds reimbursable to out-of-state healthcare providers. While the state does permit reimbursement to out-of-state physicians at a certain level, this isn't always enough to cover the cost of certain treatments or procedures you may need.

As a practical matter, this can present complications for someone who sees a primary care physician or specialist outside Delaware and wants to continue this relationship while recovering from a workplace injury. Seeking treatment from a doctor who doesn't have the benefit of your full medical history and an ongoing relationship may not always be ideal, as your best treatment plan could depend on factors not readily apparent to a doctor who hasn't seen you before. You may also find yourself unable to afford needed treatments, even though your workers compensation coverage is designed to cover all costs incurred.

What changes have been made to Delaware's workers compensation laws?

The Delaware legislature recently changed some of the reimbursement provisions of its workers compensation law to increase the benefits available to physicians outside the state. This will allow you to seek treatment from your regular doctor -- your Delaware-based workers comp policy will then reimburse your physician at a rate equal to the lesser of the "usual and customary" fee for that service or the maximum state-mandated reimbursement of either Delaware or the other state. This is a fairly generous reimbursement rate that should allow your physician to provide you with any treatment you need without losing money.