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Workers’ Compensation Medical Payments Drop In Florida


After several consecutive years of increases, medical benefits payments in the Sunshine State dropped 5 percent in 2021.

Officials blamed coronavirus for the decline. “The recent decreases in medical payments per claim in Florida and many other states reflect some impact from the COVID-19 pandemic, such as postponed or avoided medical care due to concerns about COVID-19, temporary suspensions of non-emergency surgeries during the early months of the pandemic and declined usage of hospital care because of limitations to conserve hospital capacity,” said Ramona Tanabe, executive vice-president and counsel for the Workers’ Compensation Research Institute.

Additionally, the study’s interstate comparison highlights contrasting results in Florida. While prices paid for non-hospital professional services in Florida were the lowest of the study states, Florida had the highest payments per service for hospital outpatient care, likely reflecting features of the fee schedules for different types of providers in the state.

Medical Benefits in Workers’ Compensation Claims

The average serious injury medical bill is over $50,000. The average catastrophic injury medical bill is twice that high. 5 percent may not sound like much, but 5 percent of $100,000 is an awful lot of money.

These figures include more than the hospital bill. Bills don’t stop coming once doctors discharge victims from hospitals. These additional expenses include:

  • Follow-up care, which often includes additional surgical procedures,
  • Prescription drugs, which are enormously expensive if a health insurance company doesn’t cover part of the cost,
  • Medical devices, from canes and wheelchairs to back support wraps and hearing aids,
  • Physical therapy, and
  • Occupational therapy if necessary.

Physical therapy strengthens muscles that have degraded, like shoulder muscles after a broken bone cast comes off. Occupational therapists give catastrophically-injured victims the skills they need to obtain alternative employment.

Medical bills usually start coming in before victims are admitted to hospitals. Ambulance rides aren’t free, and they aren’t inexpensive, especially if the victim needs helicopter medevac. Emergency Room medical bills are very high as well.

By law, a workers’ compensation insurance company must pay all reasonably necessary medical bills. Insurance adjusters often have a much different definition of “reasonably necessary” than victims. A Tampa workers’ compensation lawyer advocates for victims in these situations. So, they get the treatment they need, instead of the treatment an adjuster is willing to pay for.

Lost Wage Replacement

Medical bill payment is good, but it doesn’t address the financial strain these families usually feel. Typically, a job injury victim is a family’s primary or only source of income. Most families have little or no savings. Therefore, a few months without a paycheck, or even a few weeks without one, could be financially crippling.

Therefore, a Tampa workers’ compensation lawyer can also obtain partial lost wage replacement. The amount usually depends on the nature and extent of the victim’s injury, as follows:

  • Permanent Total Disability: PTD victims usually have serious occupational diseases, like serious toxic exposure cancer. They can usually get around the house and function normally. However, they cannot function well enough to work. So, workers’ compensation usually pays a lump sum to compensate these victims for their future lost wages.
  • Permanent Partial Disability: PPD cases are a bit more complex. Typically, these victims have permanent injury effects. For example, Rex’s broken ankle might never entirely heal. So, his job duties must be limited. Maybe he has to leave early because the fatigue is too much. Therefore, workers’ compensation usually pays a lump sum to compensate him for those lost wages.
  • Temporary Total Disability: Most serious injury victims are TTD victims. They cannot work until their injuries heal. Workers’ compensation usually pays two-thirds of their average weekly wages for the duration of these temporary disabilities.
  • Temporary Partial Disability: Some serious injury victims are TPD victims. They can work while they recover, but like poor Rex, they must reduce their hours or perform light duty clerical work. So, workers’ compensation generally pays two-thirds of the difference between their old and new AWW.

The AWW may be difficult to calculate, especially if the victim recently changed jobs. Most people make more money when they change jobs. Additionally, the AWW includes irregular and non-cash compensation, like overtime opportunities and tuition reimbursement.

Connect With a Hard-Hitting 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. Virtual, home, and hospital visits are available.



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