The bills start before you leave the ER. A helicopter flight from a remote lease can run more than a new truck. Then come the surgeon, the rehab and the follow ups. Who pays depends on your employer's coverage, and getting it wrong early can leave you holding bills you should never see.

Four Ways Your Bills Get Paid

If Your Employer Has Comp

Comp medical benefits are the strongest part of the Texas system. Under Texas Labor Code 408.021, you're entitled to all health care reasonably required by the nature of the injury, as and when you need it. That includes doctors, hospitals, surgery, therapy, prescriptions, prosthetics and medical equipment, for as long as the injury needs care.

For covered care, Texas law generally bars providers from billing you the difference between their charge and what comp pays. If you're getting bills for accepted comp treatment, don't pay them. Send them to the carrier and your lawyer.

Choosing your doctor

Your treating doctor runs your care and fills out your work status reports, so this choice matters. If the carrier uses a certified health care network and you live in its service area, you pick a treating doctor from the network. If not, you pick from doctors approved by the Division of Workers' Compensation. Outside a network, you can ask the Division in writing to switch doctors if the first one isn't working out.

Preauthorization and denials

Surgery, some imaging, extended therapy and certain medications often need approval before you get them. Carriers deny requests as "not medically necessary" or "not related" all the time. A denial isn't final. Your doctor can ask for reconsideration, and medical necessity disputes can go to an independent review organization.

Getting paid for the drive

Permian hands often drive a long way for specialists. Under DWC Rule 134.110, you can request mileage, and sometimes food and lodging, when the care you need isn't reasonably available within 30 miles of home and the one way trip is more than 30 miles. Keep receipts and submit within one year.

If Comp Denies the Claim

A carrier can dispute that the injury happened at work, that it's as bad as you say or that a condition is related. While that dispute plays out, treatment can stall. Your options:

Your health insurer may deny bills because the injury is work related. Tell it comp has denied the claim and keep copies of the denial letter. See dealing with your comp carrier.

If Your Employer Is a Nonsubscriber

There's no automatic medical coverage. Many larger nonsubscribers have a private injury plan that pays some medical costs. These plans usually require fast reporting, may require you to see their doctors and often cap what they'll pay. Read the plan before you sign anything tied to it. See nonsubscriber employers and oilfield waivers and arbitration.

If the company's negligence caused your injury, every medical bill becomes part of your lawsuit against it, along with future care you'll need.

How a Letter of Protection Works

A letter of protection is a promise from your lawyer to the doctor: treat now, and you'll be paid from the settlement or verdict. It lets you get surgery and therapy without waiting on an insurer, which is often the difference between healing and getting worse.

The trade off is cost. LOP providers usually bill full price, and defense lawyers attack those bills as inflated. Under Civil Practice and Remedies Code 41.0105, you can only recover what was actually paid or incurred, so a good lawyer picks providers carefully and negotiates the bills down at the end. That's money back in your pocket.

Who Gets Paid Back From Your Case

When a third party case settles, anyone who paid your medical bills may want to be repaid:

Every one of these can often be reduced. Handling them well can matter as much as the size of the settlement. See what you actually take home.

Protect Yourself Now