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Kobal Law

Who Pays Job-Injury-Related Medical Bills?


If the medical expense was reasonably necessary, the workers’ compensation insurance company is legally required to pay the bill. Frequently, insurance companies and medical providers agree on lower fees. For example, if the “list” price of an MRI is $2,000, the insurance company might agree to pay $1,000. In these situations, hospitals cannot come after the insured individuals, or in this case the job injury victim, for the $1,000 balance. More on that below.

Medical bill payment is just one of the financial benefits available to job injury victims. A Tampa workers’ compensation lawyer can also obtain lost wage replacement, even if the victim was mostly at fault, or entirely at fault, for a work-related injury. In some cases, injured workers can sue outside the system and obtain even more compensation for their noneconomic losses, such as pain and suffering.

Reasonably Necessary

As mentioned, the payment obligation only applies if a medical expense was reasonably necessary. This element is often easier to prove in Florida. Usually, injured victims must see company-affiliated doctors. Companies that give doctors the stamp of approval also approve of their methods.

However, job injury victims, like everyone else, have the right to a second opinion. A second opinion almost inevitably creates payment controversy.

Usually, insurance companies use generic tables to determine what’s reasonably necessary. For example, A injury in B zip code requires C dollars to successfully treat. But not all injuries, or all patients, are created equally.

If Ben shatters his ankle in a car crash and Jerry breaks his ankle stepping off a curb, they both technically have the same injury. But Jerry’s injury is much less expensive to treat than Ben’s. Likewise, if Ben broke his ankle previously, his recent injury will be much more difficult to treat.

Furthermore, insurance companies usually presume that the cheapest available treatment is also reasonably necessary. That’s certainly not always the case.

To establish the reasonably necessary element, a Tampa workers’ compensation lawyer often partners with an independent physician. This expert reviews the medical records and offers his/her professional opinion as to what treatment was reasonably necessary.

FDCPA Issues

The federal Fair Debt Collection Practices Act, as well as a similar Florida law, prohibits hospitals from billing patients for unpaid charges, as mentioned above. Hospitals and other medical providers cannot have their cake and eat it too. They cannot strike deals with insurance companies to get more business and bill individuals to make more money. It’s one or the other.

For reasons we don’t really understand, hospitals almost always follow this rule when a group health insurance company is involved. They almost always ignore this rule if a workers’ compensation insurance company writes the check.

Some attorneys leave job injury victims to fend for themselves in these situations. But FDCPA defense is part of what we do at Kobal. When big insurance companies try to take advantage of injured individuals, we cannot stand by and do nothing.

The laws that prohibit double-dipping also include provisions for substantial damages in these cases, including treble damages in some cases. FDCPA violations are consumer protection matters.

 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. The sooner you reach out to us, the sooner we start working for you.

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