Disability Law

Case Study: Workers' Comp Case Involving Outstanding Medical Bills

By Jodi B. Ginsberg

Welcome to the 5th installment of my summer long series on Georgia Workers' comp case studies. In the following case study, I discuss a workers' comp case involving outstanding medical bills.

Outstanding medical bills and your credit

One of the most common sources of damage to a person?s credit is outstanding (unpaid) medical bills.  If you are injured on the job, your medical bills should be covered by your employer's workers comp insurance company.  Not surprisingly workers' compensation insurers can be slow in paying medical bills and your credit may be the casualty in such a situation.   I have been retained by several clients to handle this issue because of the frustration and anger they feel when bill collectors start calling about medical debt that should have been paid weeks or months earlier by the insurance company.

Group Health vs. Workers' Compensation: a Recipe for Confusion

Under Georgia workers' compensation law, bills relating to your treatment from authorized treating physicians must be paid timely.  The law also provides that workers' compensation insurance is "primary" – meaning that group health does not come into play when there is valid workers' comp coverage.  Sometimes injured workers submit bills to a group insurance company because a supervisor instructs them to do so or because they do not realize that workers' compensation is the primary insurance source.

If the group health carrier identifies your claim as a workers' comp. claim, it will deny coverage.  If the physician's office has coded the claim incorrectly it may send your account to a collection agency.   You may be caught in the middle trying to explain to a disinterested bill collector that your bill is covered by insurance, or you may find that the "authorized" treating doctor will refuse to treat you because of "unpaid" bills.

Recently, I represented an injured worker who found himself facing both collection and a refusal by his doctor to treat because of the outstanding balance.   When we settled this case, I insisted that a provision for future medical care must be included in the settlement.  Our settlement provided for:

• monetary compensation for my client in the amount of ?X? dollars
• a confirmation that the health carrier has paid for all the current bills and will pay for any future bills from Dr. "W"
• Dr. "W" must confirm with the group carrier that he does not need any further reimbursement until further services are rendered
• medical payments and TTD continue being paid to my client pending approval of the settlement by the State Board

Please feel free to call me at 770-351-0801 if you are getting the run-around with regard to your medical bills or medical treatment.

Full post as published by Georgia Workers Compensation blog on July 01, 2010 (boomark / email).