Does Workers’ Comp Pay Medical Bills?

If an injury or illness was work related, workers’ comp, and only workers’ comp, pays medical bills, at least in most cases. Generally, workers’ compensation is the exclusive remedy for all reasonably necessary medical bills, from EMT care at the scene all the way to the last day of physical therapy. These benefits last up to five years in Florida. That’s much longer than the benefit length in many other states.

However, Florida job injury victims must typically see insurance company-affiliated doctors. These doctors often equate “reasonably necessary” with “cheapest available.” A Tampa workers’ compensation lawyer helps ensure that job injury victims get the medical treatment they need, not the medical treatment an insurance company is willing to pay for. As outlined below, a Tampa workers’ compensation lawyer advocates for victims in other areas as well.

Job Injury Medical Benefits

Reasonably necessary medical bills are consistent with the standard of care and appropriate for the victim’s particular situation.

Usually, the medical standard of care is fixed. For example, if Ralph breaks his arm, the standard of care probably requires a thorough physical examination, two advanced diagnostic tests (one to identify the problem and one to confirm the diagnosis), a medical device, which is usually a cast, and physical therapy.

The standard of care varies slightly according to ZIP code. The standard of care may be lower in rural areas that have limited healthcare access.

Medical bills are also reasonably necessary if those services were appropriate for the victim’s specific injury. Once again, a broken bone is a good example. Many broken bones are more like chipped or cracked bones. These injuries require limited medical intervention and brief physical therapy. Other times, a doctor must surgically reconstruct a shattered bone. This complicated medical procedure requires a medical device upgrade and usually more extensive, and expensive, physical therapy.

Insurance companies usually try to cubbyhole injuries into the cheaper category. A Tampa workers’ compensation lawyer helps ensure that doesn’t happen.

Billing Issues

The exclusive remedy rule, which applies in most cases, is relevant not only to medical bill payment, but also medical bill reimbursement. Victims are not financially responsible for any unpaid charges.

This issue is rather common in job injury claims. Frequently, medical providers send bills to victims for the difference between the out-of-pocket price and the insurance reimbursement price.

This practice is patently illegal under state and federal law. In many cases, a Tampa job injury lawyer can obtain treble damages if hospitals illegally send bills to job injury victims.

Nonsubscriber Cases

The exclusive remedy rule does not apply if the employer didn’t have a valid workers’ compensation policy or if certain facts are present.

Many employers lie to their carriers about risk factors, such as number of employees, job duties (roofers are more expensive to insure than secretaries), and/or payroll size. Insurance companies routinely refuse to pay benefits when, not if, their investigators uncover these lies.

Other employers are more brazen. They simply ignore the mandatory workers’ compensation insurance rule and hope they don’t get caught.

An intentional or reckless injury could also affect the exclusive remedy rule. By design, workers’ compensation only applies to unintentional injuries. Homeowners insurance companies don’t pay benefits if owners burn down their own houses, and workers’ compensation insurance companies don’t pay if the employer knew an assignment was dangerous and ignored that danger.

Work With a Detail-Oriented 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.

Source:

leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.094.html