Florida Supreme Court Empowers Medical Debt Collectors

A unanimous supreme court recently ruled that debt buyers and medical providers may directly bill job injury victims for medical services, even if a workers’ compensation insurance company was the responsible party.

In its ruling, which overturned a Court of Appeals decision, the Supreme Court drew a distinction between “matter concerning reimbursement” and a dispute alleging prohibited billing. The former involves the relationship between the billing provider and insurance carrier while the latter involves the relationship between the provider and the injured worker, according to the justices. They concluded that the exclusive jurisdiction provision of the workers’ compensation law doesn’t extend to improper billing disputes between a provider and an injured worker.

The Supreme Court’s refusal to protect job injury victims in this situation bears watching, as medical bill collectors become more and more aggressive.

Workers’ Compensation Medical Bill Payments

If the injury or illness was work-related, and the employer had a valid policy, this workers’ compensation policy covers all reasonably necessary medical bills. This category includes:

• Surface ambulance, helicopter medevac, and other transportation expenses,
• Emergency care,
• Follow-up care,
• Prescription drugs,
• Laboratory tests,
• Medical devices, and
• Physical or occupational therapy.

The “reasonably necessary” qualification triggers considerable litigation. Usually, insurance companies use one-size-fits-all tables to determine what’s reasonable. For example, the company might pay X dollars for a broken arm, regardless of the circumstances.

However, there’s a big difference between a trip-and-fall broken arm and an injury that results from a fall from a height. Additionally, not everyone can tolerate the same kinds of medical procedures, and not everyone responds to medical treatment in the same way.

A Tampa workers’ compensation attorney advocates for job injury victims in these situations. Job injury victims deserve effective treatment, and not the treatment an insurance adjuster is willing to pay for.

On a related note, medical care usually isn’t centralized. Doctors often order offsite diagnostic tests and give patient referrals. As a result, it’s often hard for medical providers to define what’s work-related and what isn’t. More accurately, these providers often don’t care who pays a bill, an individual or an insurance company. They just want payment.

Medical Debt Collection Issues

Providers have legal responsibilities in this area. The medical provider duty of care requires them to obtain specific information about the nature of the injury. This information is a critical part of the patient’s medical history. Medical providers have a fiduciary duty to collect such data and incorporate it into their treatment plans.

A fiduciary duty is the highest level of legal responsibility in Florida law. Essentially, doctors must disregard all other priorities, such as making money and work-life balance, and do what’s best for their patients. This duty applies because doctors have considerable experience and training in the medical field. Patients have almost none of these things.

Some practical issues may exist as well. Most insurance companies, including workers’ compensation insurance companies, use set fee schedules. For example, a provider might normally charge $1,000 for an X-ray, and the insurance company might pay $500. If that’s the case, the provider cannot bill the job injury victim for the remaining $500. 

Work With a Thorough Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced Tampa workers’ compensation lawyer, contact Kobal Law. Home, after-hours, virtual, and hospital visits are available.