Top Five Covered Medical Expenses in Workers’ Comp Cases

Since 2000, medical treatment costs have increased over 120 percent. That’s much higher than the overall inflation rate. Most group health insurance policies exclude work injury or disease-related costs, for liability reasons. Since most families live hand to mount, they cannot possibly afford to pay these staggering costs out of pocket.

A job-related “injury” is usually a trauma injury, like a fall. Other job-related injuries occur slowly over time, such as hearing loss.

Because of these high costs, the medical bill payment benefit might be the most important financial benefit in workers’ comp cases. Under the law, the insurance company must pay all reasonably necessary expenses. Unfortunately, to most insurance adjusters, “reasonably necessary” is synonymous with “cheapest available.” A Tampa workers’ compensation lawyer helps ensure that job injury victims get the treatment they need, not the treatment an adjuster is willing to pay for.

Transportation

The increasing cost of emergency transportation is one of the main reasons medical bills have increased so much. That’s especially true of medevac transportation. A brief helicopter ride could cost more than $40,000, which in some cases, is more than the ER bill.

Adjusters almost never approve such costs. They believe, sometimes accurately, that a much less expensive surface ambulance ride would’ve been sufficient.

However, in most cases, job injury victims are either unconscious or semi-conscious. They have no input into the transportation mode. Even if they’re awake, arguing with first responders about emergency transportation is a bad idea and probably a losing proposition.

In fact, if a victim declines medevac transportation against the advice of emergency responders, most adjusters refuse to pay for the “unreasonable” alternative transportation. So, they don’t approve it either way.

Emergency Care

Many times, roughly the same thing happens in the emergency room. Unconscious or semi-conscious victims cannot argue with doctors as to the appropriate level of care.

Furthermore, at this point, Florida’s physician choice rule, or rather the lack of choice rule, often comes into play. Company doctors often stabilize seriously injured victims, and that’s about it. As a result, they require additional emergency care at another facility.

Follow-Up Care

ER doctors don’t have magic wands that instantly cure job-related injuries. Usually, the treatment program is just beginning at this point.

Severe cuts, a common injury in falls or motor vehicle crashes, are a good example. The stitches must come out eventually. Additionally, different doctors approach post-injury wound care differently. Sometimes, a doctor might effectively undo the work that a prior doctor performed.

Physical Therapy

This phase could include physical therapy and/or occupational therapy. Most job injury victims begin with physical therapy to help them regain strength. If this therapy doesn’t go well, many victims transfer to occupational therapy, so they can learn to work another job with their remaining physical function.

Ancillary Costs

Like medical bills themselves, ancillary costs add up quickly. These costs usually include prescription drugs and medical devices.

Most people don’t appreciate the high costs of such items, since a health insurance company pays most or all of the bill. However, as mentioned above, most health insurance plans don’t cover injury-related costs. So, the victim must pay the entire amount.

The same thing is true of diagnostic and recovery progress tests, such as MRIs. If the hospital bills the patient for the out-of-pocket cost, which it probably will, the workers’ compensation insurance company is liable for that amount, not the insurance reimbursement amount. The provider might agree to reduce the charges later, but that dispute is between the insurance company and hospital.

 Rely on a Savvy 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. Virtual, home, and hospital visits are available.

Source:

healthsystemtracker.org/brief/how-does-medical-inflation-compare-to-inflation-in-the-rest-of-the-economy/#Cumulative%20percent%20change%20in%20Consumer%20Price%20Index%20for%20All%20Urban%20Consumers%20(CPI-U)%20for%20medical%20care%20and%20for%20all%20goods%20and%20services,%20January%202000%20-%20June%202024