What Benefits Can You Collect

Under the LHWCA you are entitled to receive, and your employer must pay for, all “reasonable and necessary” medical benefits which are directly related to your accident and injury. There is no monetary cap or limit on the amount of medical benefits that you can collect under the LHWCA as long as the treatment and/or surgeries being recommended are determined to be medically “reasonable and necessary.” However, the cost that your medical provider is allowed to charge for such treatment and surgeries is limited to a certain schedule of amounts.

Very often an employer under the LHWCA will fight and contest whether treatment and/or surgery is reasonable and medically necessary. Your employer may do this by sending you to its choice of examining physician to have their doctor evaluate you. Then, their doctor may issue a report stating that you are at maximum medical improvement and do not need any further medical treatment, or their doctor may specifically disagree that a recommended treatment and/or surgery is reasonable and necessary. Typically your employer will then refuse to pay for such medical treatment and/or surgery under the LHWCA. It is important to remember that you are entitled to any medical treatment and/or surgery which is ultimately determined to be medically reasonable and necessary. If your employer refuses to approve medical treatment or benefits, very often this issue will have to be addressed by an Administrative Law Judge through a Formal Hearing which is the claims process to have disputes resolved under any LHWCA claim.