GETTING BILLED FOR PRE-AUTHORIZED COMP TREATMENT? IT COULD BE WORTH A QUICK $1,000 OR MORE!
If you have a workers’ compensation case in the state of Florida, there is a good chance that you received a medical bill from a doctor demanding payment. If this happened to you, I am sure your knee-jerk reaction was “This is workers’ comp’s fault!” Believe it or not that is rarely the case–it’s almost always the medical provider’s fault. The statute has rigid requirements that only allow a carrier to reimburse medical providers who submit their bill on specific workers’ compensation forms. Each itemized service gets reviewed item by item and then the bill provider is reimbursed using the workers’ compensation fee schedule which pays less than any other type of insurance. Many providers opt to just bill the injured worker instead. If that happened to you that just may result in a quick $1,000 as a violation of your consumer rights.
A common occurrence in the state of Florida is when injured workers get billed for what is considered pre-authorized care. If you get hurt and thrust into the work comp system here in Florida you soon discover that the carrier picks just about all of the doctors that can possibly treat you for your work-related injuries. Pre-authorized care is when the workers’ compensation carrier informs one the chosen physicians in writing that they were officially authorized to treat you for your work comp case. Therefore, if one of those doctors bills you, it is practically impossible for them to claim that they did not know the treatment was for a compensable work related injury. I will explain why that is so important, and why that makes a strong case against an authorized comp doctor for billing and harassing you for payment.
In order to prevail under the FCCPA and obtain your $1,000 statutory penalty you must prove three elements: 1) The debt was illegitimate; 2) There was an attempt to collect; 3) The doctor had actual knowledge that the debt they billed for was illegitimate. Davis v. Sheridan Healthcare, Inc., 2D17-1790, 2019 WL 5198669 (Fla. 2d Dist. App. Oct. 16, 2019).
In FCCPA cases that involve injured employees getting illegally billed, the first two elements are almost always met after an injured worker receives a bill in the mail. The most challenging element to overcome in these cases is the third element of actual knowledge. However, an FCCPA case against an authorized comp doctor can usually easily get over that hurdle given these doctors are pre-authorized in writing by the carrier. If an authorized treating doctor bills you for medical treatment related to your work injury, it is almost always a clear FCCPA violation.
Injured employees have a lot to worry about when they open their workers’ comp case. Will I still have a job? Will my employer offer me light duty? Will I receive workers’ comp checks? Will I receive medical treatment? These are all questions injured employees may ask themselves when they’ve never dealt with the workers’ compensation system before. The last thing you want to be worried about is a doctor illegally billing you for medical treatment you are not responsible for. The killer of it all is that if you sit back and don’t do anything about these bills, letters from collection agencies and negative credit reports will follow. All for a debt that you do not owe to begin with! In 2019 the state of Florida’s Supreme Court deemed this a matter of great public importance and it truly is.
If this has happened to you make sure to get representation to avoid being strong-armed by your workers’ comp insurance carrier and workers’ comp doctors. We take pride in making sure we protect our injured employees, so if you have received a bill related to your workers’ comp case, please give our office a call.