Advanced Medical Bill Issues in Workers’ Comp Matters

Job injury claims are deceptively simple, mostly because liability (legal responsibility), the key element in these claims, is so easy to establish, at least in many cases. Job injury cases are no-fault cases. The victim must only establish a connection between the victim’s work environment and the claimed illness or injury to obtain full benefits. Fault is irrelevant.
As outlined below, the advanced issues which are normally part of these cases are anything but straightforward. Establishing liability may be the key basic element of a workers’ compensation claim, but maximum benefits are only available if a Tampa workers’ compensation lawyer also addresses the advanced medical bill issues discussed below. Lost wage replacement is the other major financial benefit in workers’ compensation matters.
Reasonably Necessary
Workers’ compensation insurance companies must pay all reasonably necessary medical expenses. This list includes:
- Paramedic or other professional treatment at the scene,
- Transportation to a hospital,
- Emergency medical care,
- Follow-up medical care,
- Physical therapy, and
- Ancillary expenses, like prescription drugs and medical devices.
However, the “reasonably necessary” requirement is very difficult to prove, especially in states like Florida. In the Sunshine State, job injury victims must see company doctors who determine what treatment, if any, is reasonably necessary.
To address this issue, a Tampa workers’ compensation lawyer usually connects job injury victims with independent physicians. Florida law doesn’t prevent job injury victims from obtaining second opinions.
A treating physician usually goes beyond issuing an opinion and orders proper medical care. Generally, these doctors charge nothing upfront for their professional services. Likewise, other medical providers usually don’t charge anything upfront.
Other hurdles remain in this area. Most importantly, the “reasonably necessary” requirement often isn’t self-proving. The treatment a doctor orders might or might not be reasonably necessary under the law.
To establish this requirement, a Tampa workers’ compensation lawyer often partners with another doctor who reviews treatment and renders an opinion in this area. Once again, these doctors usually don’t charge any money upfront.
Fair Debt Collection
A discussion of this advanced medical bill issue requires a bit of background. Most hospitals charge one rate private pay patients and a lower one for insurance companies. A hospital might charge Alice $1,500 for an MRI and agree to pay her insurance company $500.
Frequently, medical providers send bills to job injury victims for the gap between the two. So, if Alice’s injury was work-related, XYZ hospital would take the workers’ compensation insurance company’s $500 and send Alice a bill for $1,000.
This practice is very common. Most hospitals have separate insurance and private pay billing/collections departments, and the right hand doesn’t know what the left hand is doing.
This practice is also clearly illegal under both state and federal debt collection laws. Some victims are entitled to treble damages in these cases, because of the medical provider’s callous indifference to applicable laws.
When a Tampa workers’ compensation lawyer takes corrective action in these cases, the provider usually changes its policies, thus protecting future job injury victims, who are going through perhaps the worst time of their lives, from such blatant misconduct.
Count on a Hard-Working Hillsborough County Lawyer
Injury victims are entitled to important financial benefits. For a confidential consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We routinely handle matters throughout the Sunshine State.