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What Are The Covered Expenses Under Workers’ Compensation Programs?

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Medical bills are the primary covered expenses under Florida’s workers’ compensation program. These bills are usually very high. The average injury-related medical bill is over $55,0000. The medical bills related to chronic illnesses, such as cancer, could be many times higher. Group health plans usually do not cover injury-related costs. Typically, if there’s any chance another party, like a workers’ compensation plan, might pay the expense, health insurance companies deny payment.

So, unless a Tampa workers’ compensation attorney fights for these benefits in court, the victims could be financially responsible for these bills. Medical bill payment is just the beginning. Workers’ compensation also replaces lost wages. Furthermore, medical bill payment and lost wage replacement benefits are normally available even if the victim was partially, mostly, or entirely at fault for the accident or other incident which caused injury or illness.

Covered Expenses

In short, every medical bill from the first moment of emergency treatment to the last day of physical therapy is usually covered. That’s a very broad category, so let’s break things down a little.

Emergency medical technicians are usually the first medical professionals to treat injury victims. At a minimum, the EMT bill is usually several thousand dollars. If responders had to airlift the victim to a hospital, the EMT bill could be even higher than the hospital bill.

Most hospitals charge about $3,500 per day. Intensive care treatment is much more expensive. Since most serious injury victims must spend at least a week or two in a hospital, these costs add up quickly.

Furthermore, the costs are just beginning. Once they are discharged from the hospital, victims require ongoing medical care. They usually need medical devices and prescription drugs as well. Group health plans usually pay most or all of these costs. Therefore, many people don’t really understand how expensive these things are.

Once initial medical treatment is complete, physical therapy is usually next. The law recently changed in this area. In the Sunshine State, the medical payment benefits now usually last 104 weeks. So, victims generally have plenty of time to fully recover from their injuries. In some cases, victims might need additional occupational therapy. That’s for victims who are so seriously injured they must learn a new trade.

Insurance Company Defenses

As mentioned, workers’ compensation insurance companies usually cannot contest fault. But they can, in some cases. Additionally, insurance companies can also argue that a medical expense is unreasonable.

Many people have pre-existing conditions, such as an illness, old injury, or unhealthy off-work environment, that increases the chance of a work-related injury or illness. In these situations, a Tampa workers’ compensation attorney must prove that the work environment or injury aggravated the pre-existing condition, as opposed to the other way around. That’s a very fine line which is why many attorneys partner with independent doctors in these situations.

Arguments about reasonable necessity often involve extended physical therapy. Most insurance companies use boilerplate charts (e.g. X injury means Y physical therapy visits) in these situations. But all victims recover at their own pace. If the victim’s progress plateaus for any reason, an attorney can keep the money flowing until the victim reaches Maximum Medical Improvement (MMI). At that point, if the injury is still disabling, the victim might be entitled to a lump-sum payment which could apply to future medical expenses.

Work with a Compassionate 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 do not charge upfront legal fees in these matters.

Resource:

cdc.gov/mmwr/preview/mmwrhtml/mm6340a4.htm

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