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Kobal Law

Medical Evidence In Florida Workers’ Compensation Claims


In 2020, work injury-related medical expenses totaled almost $35 billion. Overall medical expenses, including job injury-related medical bills, have increased significantly since the 2008 Great Recession ended. However, workers’ compensation medical benefits have declined over this same period, mostly because workers’ compensation insurance premiums have dropped significantly over this same period. Less money in the system means Claims Examiners are stingier than ever when it comes to determining which medical bills are “reasonable” and which ones aren’t.

If a settlement doesn’t fully account for both past and future expenses, victims may be financially responsible for either or both of these charges. A good Tampa workers’ compensation lawyer doesn’t let that happen. Frequently, attorneys partner with top doctors who thoroughly review files and offer their expert opinions. Their conclusions about what’s “reasonable” are much more compelling than the conclusions of an insurance adjuster.

Prior Expenses

We’ve mentioned the r-word (reasonable) several times. That’s because, under Florida law, workers’ compensation insurance companies must pay all reasonably necessary medical bills.

Insurance adjusters usually look to boilerplate charts to determine what’s reasonable. For example, if Larry breaks his arm at work, Company A might pay X dollars in medical bills and Y number of physical therapy sessions. These “reasonable” figures are usually based on statistics. They have nothing to do with Larry or his injury. Additionally, Company B might have a different definition of what’s “reasonable” under the same circumstances.

The aforementioned medical expert takes a case-specific view. S/he bases “reasonable” expenses on Larry’s injury and Larry’s response to treatment, not general statistics.

Workers’ compensation doesn’t just pay for direct medical expenses, like emergency care and physical therapy. It also pays for ancillary expenses, like transportation, prescription drugs, and medical devices.

Frequently, ancillary expenses are almost as much, or more than, direct expenses. For example, if Larry’s injury is more serious, he might require helicopter medevac to a nearby hospital. A few minutes could cost more than $40,000.

Workers’ compensation also replaces lost wages. Typically, victims receive two-thirds of their AWW (average weekly wage) for the duration of their disabilities. A Tampa workers’ compensation attorney must properly calculate the AWW to ensure maximum benefits.

Future Expenses

If victims reach their MMI (maximum medical improvement) and they still aren’t 100 percent, future lost wage replacement is usually available, again based on the victim’s AWW.

Future medical expenses usually involve future surgeries and future physical therapy. Once again, careful calculation is required. Some of this calculation involves estimation. Medical expenses aren’t the same from year to year. Occasionally, they go down. In almost all cases, they go up. Tomorrow’s ankle surgery is almost always more expensive than today’s ankle surgery.

Compensation for future ancillary expenses is available as well. Prescription drugs are a good example. Many of us don’t know how much these drugs are, since a health insurance company pays most of the cost. If a victim is financially responsible for these costs, they can be devastating. Once again, an attorney won’t let that happen.

 Contact a Dedicated Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We routinely handle matters throughout the Tampa Bay area.


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