What Medical Bills Does Workers’ Compensation Pay?

Generally, workers’ compensation pays all reasonably necessary medical bills directly to providers. Florida’s law in this area is a little unusual. According to Section 440.20, “Unless the carrier denies compensability or entitlement to benefits, the carrier shall pay compensation directly to the employee.” We’ll unpack this complex definitions, and some of its implications for job injury victims and their families, below.

Medical bill payment benefits are just some of the benefits available to job injury victims. A Tampa workers’ compensation attorney can also obtain partial lost wage replacement. Usually, victims are entitled to two-thirds of their average weekly wage for the duration of a temporary disability. Since Florida law recently changed on this point, job injury victims are entitled to lost wage replacement benefits much longer than they were before. If the victim sustained a permanent injury, a lump sum payment is usually available.

Compensable Benefits

Generally, medical bills are compensable if they are work related. Legally, insurance companies cannot blame victims for work-related injuries. However, they can and do content this element, especially if the injury happened “off the clock” or a pre-existing condition contributed to the risk and/or severity of injury.

An injury during a company softball game is the classic example of an “off the clock” work-related injury. These games benefit employers, not only because they make their employees happier and healthier, but also because the game generates brand awareness. Because of these benefits, gme-related injuries are also work related, at least in most cases.

Hearing loss is the classic example of a pre-existing condition. Most people hear loud noises throughout the day, not just at work. Insurance companies often try to use constant noise as an excuse to deny medical bill payment. However, these bills are compensable, as long as the work injury aggravated the pre-existing injury, and not vice versa.

Entitlement to Benefits

Workers are entitled to benefits if the medical expense was reasonably necessary. Once again, in many cases, questions abound in this area.

Generally, insurance companies use one-size-fits-all actuarial tables to determine if a medical expense is reasonably necessary. For example, a broken arm might require four physical therapy appointments, as far as insurance company bean counters are concerned. So, if the victim requires five visits, the fifth one isn’t reasonably necessary.

Denials based on issues like this one usually don’t hold up in court. However, they create enough doubt to trigger an initial Claims Examiner denial. That’s the main reason the initial denial rate has gone up so much in recent years.

Direct Payments to Employees

The direct payment requirement usually means higher medical bills and additional hassle, unless the victim has a Tampa workers’ compensation lawyer.

Assume Tammy gets hurt at work and incurs $10,000 in medical bills. Under Florida law, she’s financially responsible for every nickel. Moreover, if she wants to do something like set up a payment plan, she must do that on her own. Tammy’s lawyer could negotiate with medical providers and reduce her $10k bill to perhaps $8k or even less. Additionally, Tammy’s attorney handles all repayment aspects. As a bonus, direct payment allows victims to bypass Florida’s complex collateral source rule.

 Reach Out to a Compassionate Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced job injury lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.

Source:

leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0440/Sections/0440.20.html