Medical Bills, Medical Debt, and Workers’ Compensation
Despite attempts to address the issue, high medical bills are still the leading cause of consumer bankruptcy filings in the United States. Most of these bankruptcies involve long-term disease care or serious trauma injury care. The average hospital stay costs $4,000 per day. At that rate, even if a health insurance company pays most of the cost, unpaid bills add up quickly.
By law, workers’ compensation insurance companies are required to pay all reasonably necessary bills connected to a job-related injury or illness. Insurance company lawyers look for loopholes which enable them to reduce or deny medical bill compensation. Despite what TV commercials imply, insurance companies try to avoid paying claims. Only a Tampa workers’ compensation lawyer evens the odds.
Workers’ Compensation and Medical Bills
The medical payment benefit applies to all expenses incurred at every stage of the illness or injury treatment process. Disputes as to what’s reasonably necessary arise at every step of the treatment process as well.
- Transportation: Insurance company adjusters usually approve the next-lowest transportation cost. For example, if a victim was medevaced to a hospital, the adjuster will only pay for the cost of a surface ambulance ride. However, in this case, a doctor or emergency responder, not an insurance pencil-pusher, decides what’s reasonably necessary.
- Emergency Care: Many job injury victims require extensive medical treatment. But they’re in such poor physical condition that doctors must address these needs on a piecemeal basis. This approach drives up the cost of emergency care. Once again, the insurance company must pay the actual cost, not a theoretical cost.
- Physical Therapy: MMI (Maximum Medical Improvement) is a key acronym in workers’ compensation physical therapy disputes. Once a victim reaches MMI (as good as it gets), the insurance company immediately pulls the financial plug. A Tampa workers’ compensation lawyer works to ensure continued funding and additional recovery.
Falls are the most common job-related trauma injury. These injuries occur not only at places like construction sites. Office workers often fall as well, usually due to loose carpet, floor clutter, or open desk drawers.
Toxic exposure may be the most common job-related occupational disease. In a civil case, it’s difficult to connect toxic exposure with a specific source. But since workers’ compensation is no-fault insurance, the connection is easier to make in these matters.
Workers’ Compensation and Medical Debt
These disputes usually revolve around the gap between out-of-pocket price and insurance-reimbursed price. For example, the out-of-pocket cost for an MRI might be $10,000, but the hospital agrees to reimburse the insurance company $4,000 and write off the remainder.
Frequently, hospitals accept $4,000 from a workers’ compensation insurance company and send the victim a bill for $6,000. This practice is illegal under several sections of Florida and U.S. law, most likely the laws controlling fair debt collection practices.
The Supreme Court has rolled back some FDCPA protections in recent years. Although these rollbacks don’t affect workers’ compensation reimbursement, they have emboldened hospitals to be more aggressive in this area.
Workers’ compensation medical bill reimbursement is subject to the reasonably necessary requirement, which was discussed above.
Lost wage replacement is a closely related workers’ compensation benefit. The medical bill payment benefit pays these expenses, but it doesn’t cover living expenses while the victim is unable to work. Usually, workers’ compensation pays two-thirds of lost wages for the duration of a temporary or permanent disability.
Connect with a Thorough 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.
