What Does Lifetime Medical Mean? Workers’ Comp Lifetime Medical Buyout

Workers’ compensation law requires employers or their insurance companies to provide benefits to workers who get sick or injured due to work-related causes. 

This is meant to protect both employers and employees. Employers who have coverage can protect their business from devastating financial loss when serious accidents take place. Employees are also assured that they’d get financial assistance when they suffer from injuries or conditions that may affect their health, life, and livelihood.

Some of the benefits that employees can receive include medical treatment fees, disability, wage replacement, costs of ongoing care, and death benefits. In Virginia, workers are also entitled to medical lifetime benefits.

What Are Lifetime Medical Benefits?

Under the Virginia State Code, workers may be awarded lifetime medical benefits when they suffer an injury while they’re on the job. This gives them the right to free medical coverage for treatment for all conditions, illnesses, or injuries that are work-related. This coverage will last for the length of the worker’s life.

Lifetime medical benefits includes the following:

• Fees for visits, exams, and referrals made by the authorized physician
• Hospitalization costs
• Costs of all reasonable and medically necessary injections, procedures, and surgeries
• Expenses for mental health or psychiatric care
• Costs of specialized treatment or emergency care
• Costs of diagnostic tests, scans, and exams
• Purchase of equipment that may be medically required so the worker can deal with their illness or injury such as wheelchairs, filtration devices, or ergonomic chairs
• Costs of physical or occupational therapy
• Costs of home nursing care

The list above isn’t exhaustive. If the authorized physician recommends a treatment, device, or medication that can help the worker improve their condition, it will most likely be covered under the lifetime medical benefits award.

How Is Lifetime Medical Benefits Different from a Settlement?

A settlement refers to a lump sum given to a worker who suffered from a work-related injury. Unlike lifetime medical benefits which are awarded by the Virginia Workers’ Compensation Commission, a settlement is offered by the employer or their insurance company, and the worker and the amount is often up for negotiation

The value of the settlement is typically based on certain factors including the extent of the injury, projected medical costs, and the risks of winning or losing if the case gets litigated. 

Opting for a settlement means that the worker is going to get the amount right away. They can manage their own treatment and they won’t have to confer with their employer or its insurance agency for any changes in physicians or treatments. 

However, taking a settlement also means that the worker forfeits their right to future lost wages and other benefits, including lifetime medical benefits.

The Benefits of Keeping A Lifetime Medical Award

Although a lot of workers may choose to get a settlement, there are benefits to keeping a lifetime medical award. Here are some of them:

• There’s no need to worry about increases in healthcare costs. If the injury or illness that the worker sustained is permanent or recurring, accepting a settlement means that they may have to worry about not having sufficient funds to pay for treatment when the costs increase in the future.
• There’s no limit on the amount that the insurance company will have to pay for any treatment related to the worker’s injury.
• The worker will get reimbursements for gas and transportation costs that the worker will incur to get to their medical appointments.
• There are no deductibles or copays. The insurance company pays for the full cost of the treatment. They’ll also assist with handling the claim, verifying payments, and scheduling visits or appointments.

The Benefits of Accepting a Lifetime Medical Buyout

Legally, an employer and their insurance company can’t force you to accept a settlement or a buyout of your lifetime medical benefits. However, accepting a buyout makes sense in the following scenarios:

• The worker may not need additional treatment
• The worker wishes to get treatment from their chosen physician
• The worker does not wish to deal with stress of litigation
• The worker does not wish to wait until the employer or insurance company can find a physician that will accept the coverage
• The worker has private health insurance

In Virginia, Contact Slominski Law Today

If you are involved in a workers’ compensation case in Virginia and are unsure about which direction to take, consult Slominski Law for an experienced lawyer who knows what it takes to help you navigate your situation.

Call us at (434) 384-9400 to reach our Lynchburg Office or at (540) 554-3762 for our Roanoke Office, or book a consultation online.