In today's world, insurance companies are continuing their aggressive efforts to control (reduce) what they pay for your health care. They are also doing whatever they feel they can get away with to make it difficult to obtain fair and reasonable compensation for legitimate claims. As a result, individuals with legitimate health care needs and injury claims find it difficult to get the care they want and need. Health insurers, HMO's, worker's compensation insurers and automobile insurers have adopted a policy that puts their pocketbooks first and individual's health care needs second. The result for the individual is confusion about options available and delays and denials of claims that should be paid. This guide hopefully will help the individual understand insurance options available in various situations should they become a victim of these aggressive insurance practices.

Suggestions for dealing with common problems

• Worker's compensation carrier denies a claim or bill - Request a hearing before the agency in your state that administers worker's compensation claims. In the meantime give your doctor your health insurance information.
• Worker's compensation carrier tries to get you to use a different doctor- Most states give you the right to choose your own doctor. Check with the state agency or an attorney that does worker's compensation work.
• Worker's compensation carrier says it is stopping benefits- Request a hearing before the state agency and give  your doctor your health insurance information.
• Health insurer refuses to pay because of no referral - Get a referral. Use medical payments coverage if injury from an auto accident or fall. Consider a claim against the person responsible for the injury.
• Health insurer does not pay the whole bill - Use medical payments coverage if injured in a fall or auto accident. Consider a claim against the person responsible for the injury.
• Auto accident or fall and no health insurance - Use medical payments coverage. Pursue a claim against the person responsible and have your attorney explore a guarantee of payment arrangement from settlement or judgment with the doctor.

This is partial list of some common problems and possible solutions. The important thing to remember is that there is probably a way to get the care you need. Discuss your options with your doctor and make sure your doctor knows the coverage available to you. If you have any questions about coverage, speak with an attorney familiar with insurance matters. You have rights, don't be talked out of asserting them.

Insurance available to injured persons

• If you are hurt at work, the first option is worker's compensation insurance. Worker's compensation has to pay medical bills related to the injury. If there is a denial, any health insurance should be contacted and a claim filed with the agency in your state that oversees workers compensation claims. If the injury was someone else's fault, think about a claim against that person or company's liability coverage
• If you are hurt in a car, if there is insurance on the car it probably includes medical payments , (Personal Injury Protection in some states). That can be used no matter whose fault the accident was. Your own auto policy can probably also be accessed. In addition, health insurance can be used though your health carrier will have a right to be re-imbursed if the accident was someone else's fault and a claim is pursued. If the accident is someone else's fault, that person's insurance company can be made to pay. If they are not insured, your auto insurance company can be made to pay through your uninsured auto coverage.
• If you are hurt in a fall, health insurance is available. Also, many places have premises medical payments coverage (ASK!!) and if so the insurance company providing the coverage has to pay. If the fall was not your fault, the liability coverage for the location where you fell is probably available.

Disclaimer

This guide is for general information only. Laws and coverage may vary from state to state and certainly country  to country. This guide is not a substitute for legal representation. Specific problems should be discussed with your lawyer and your doctor.