How are Medical Bills Paid Under Workers' Compensation?
Direct payment is the norm in worker's compensation matters.
Legally, the worker's compensation insurance company must pay all reasonably necessary medical expenses that are connected to a work-related illness or injury. This category includes not only medical treatment bills (doctor, hospital, diagnostic tests, etc.) but also ancillary expenses (transportation, prescription drugs, medical devices, etc.).
A fundamental misunderstanding affects many worker's comp claims. Most insurance adjusters firmly believe that “reasonably necessary” and “cheapest available” are synonymous phrases. No matter what TV commercials imply, insurance companies only care about corporate profits. In contrast, a Tampa worker's compensation lawyer has the same level of commitment to work injury victims. That commitment makes all the difference.
Direct Payment
Legally, the worker's compensation insurance company must directly pay all covered medical expenses, and victims aren’t financially responsible for any unpaid bills. At least, that is the way worker's comp is supposed to work. The system sometimes breaks down. More on that below.
However, the insurance company must only pay medical bills once the insurance company and the victim settle the case. In a few cases, a quick settlement is in the victim’s best interests. But in most cases, a quick settlement is a bad idea.
Future medical costs are one reason to avoid quick settlements. Many work-related injuries are permanent, at least to an extent, and require ongoing medical care. If the settlement does not account for possible future medical costs, the victim is normally financially responsible for these expenses.
To determine a reasonable amount of future medical costs, a Tampa worker's compensation lawyer normally partners with an independent doctor.
The insurance company could also challenge the reasonable necessity of prior bills. Transportation is a good example.
Usually, adjusters approve the next level down. If an ambulance transported Amy to a hospital, the insurance company might only pay for the cost of an Uber ride. Amy’s Tampa worker's compensation lawyer must prove she needed medical treatment during transportation, as opposed to a ride to a hospital.
Collection Issues
Although the law clearly states that work injury victims are not financially responsible for any reasonably necessary medical expenses, many providers “accidentally” send gap bills to victims.
These gap bills are the difference between the private pay price and the insurance price. For example, if Lab X charges $500 to test blood samples, it may negotiate a $50 fee with an insurance company. Such renegotiation is perfectly legal. But if Lab X sends the victim a bill for $450 (the insurance pay/private pay gap), that act violates several state and federal debt collection laws.
These matters are tricky because the Supreme Court recently diluted the consumer protection provisions in the Fair Debt Collection Practices Act. So, lawyers must aggressively advocate for victims to preserve their legal and financial rights in these matters.
On a side note, Florida's debt collection restrictions are much broader than federal debt collection protections.
“Jumping the gun” collection is also illegal in worker's compensation cases. As mentioned, the payment requirement kicks in when an attorney resolves the case. In the meantime, debt collection laws usually prohibit creditors from communicating with individuals.
Count on a Diligent Hillsborough County Lawyer
Victims need and deserve compensation for their serious injuries. For a confidential consultation with an experienced worker's compensation lawyer in Tampa, contact the Rooth Law Firm. Mr. Rooth is a Board-Certified attorney in workers' compensation law by the Florida Bar Association, a distinction that fewer than one percent of all Florida lawyers have.