The Affordable Care Act (aka Obamacare), Pre-Existing Conditions, and My Workers’ Comp Medical Treatment After Settlement in Pennsylvania (PA)

Receiving reasonable and necessary medical treatment for a work injury in Pennsylvania (PA) can often be difficult and frustrating when dealing with a workers’ compensation insurance carrier. We have covered in other posts the ways insurance companies can delay the process and make an injured worker jump through hoops to get the treatment he or she needs and deserves and the proactive steps we can take to obtain treatment.

Lately, there has been a lot of talk about the Affordable Care Act (ACA), also known as “Obamacare”, and how it might affect the health care that every citizen receives. While it might not have a significant effect on the treatment an injured worker receives while on workers’ comp, there are important consideration that an employee should consider when looking to settle a workers’ comp case.

Generally speaking, if an insurance company is going to settle a workers’ compensation case through a Compromise and Release Agreement, the insurance company will usually say they want a settlement of the entire case, including wage loss or indemnity benefits and all medical treatment. While lump sum settlement may be appealing in many ways, many injured workers who are actively treating for their work injury or may need major treatment or surgery in the future should be hesitant to forfeit their rights to future medical treatment

One purported perk of the ACA is that, as of January 1, 2014, insurance companies can no longer deny coverage based upon a pre-existing condition, cannot charge a higher premium based upon a pre-existing condition, and cannot refuse to cover treatment for pre-existing conditions. According to, Pennsylvania currently has 5,489,162 non-elderly people with some type of pre-existing medical condition. These millions of Pennsylvania residents, including many injured workers, can very soon benefit from the passage of this Act. While it’s too early to know the types of treatment and the quality of this care available to persons with pre-existing conditions, this recent development is still an important factor for an injured worker to consider when looking at settling his or her case.

For more information on the ACA and pre-existing conditions, visit If you have a question as to how the ACA will affect your benefits and your case, reach out to an experienced workers’ compensation lawyer.