Are My Medical Bills Covered Under Florida’s Workers’ Compensation Laws When I was Sent By My Work Comp Insurance Company?

Injured workers sent by a Florida workers’ compensation insurance company for medical services are never responsible for payment of the bills. This includes all medical care, regardless of whether it is with a clinic, a hospital, an MRI facility, a therapist, a surgeon, a pharmacy or any other medical provider.

In taking on a worker’s compensation patient, an agreement is reached wherein the provider agrees to accept a reduced rate for their services. For example, when a bill generated for $1,000.00 following an office visit and examination is sent to a workers’ compensation insurance company, work comp only pays $300.00. The doctor has to eat the difference. They cannot pass along the $700.00 difference to you, the injured worker. This is called a Fee Schedule (The above sums are estimates and not exact calculations under a Fee Schedule agreement).

The only time an injured worker may ever have to pay for medical care is after they have been placed at Maximum Medical Improvement by all treating doctors and must then pay a $10.00 co-pay for all future care.

However, even though medical providers who take on workers ‘ compensation claimants under the Fee Schedule agreement know they are not to bill the client, there are certainly many injured workers who receive bills and even collection notices. This type of activity has to be addressed immediately and the services of an experienced workers’ compensation attorney will be required to rectify the issue.

There are other instances when bills are sent to an injured worker rather than to the Florida workers’ compensation carrier. Many ambulance companies are run by small towns or municipalities that are not aware that there is a workers’ compensation insurance company to bill. So, even though EMS shows up to an office building, or provides care to someone at their desk, they do not handle the administrative part of the job nor control where the bill goes. If you think a regular ambulance bill is pricey, wait until you see a trauma hawk helicopter bill.

Other scenarios where bills are incorrectly sent to an injured worker include facilities that have multiple service providers. The best examples of these include hospitals and surgery centers. In these facilities you have not only bills from the hospital or surgery center themselves, but you also have bills from the attending doctor or surgeon, the nurse, the anesthesiologist, the pathology lab (blood work), the Imaging facility (x-ray, MRI’s, CT’s, etc) and more. Though the doctor or the hospital may know not to bill the injured worker, the smaller vendors are not advised to send the invoice to workers’ compensation and may incorrectly send it to you.

In certain, limited, circumstances, Florida’s workers’ compensation law allows an injured worker to obtain emergency room or hospital treatment without the approval of their workers’ compensation carrier and not have to pay the bill. To access this type of care, you will best be served by having the advice of an experienced workers’ compensation attorney to make sure the bill is handled properly so you are not stuck with what could be astronomical bills.