Due Diligence Prior to Settling Your Workers’ Compensation Case

When you are injured while performing your job duties, you will undoubtedly need medical treatment for your injury(ies). If your claim is accepted by the workers’ compensation carrier, whether you are paying both wage loss benefits and medical benefits or just medical benefits with a panel provider, your medical bills should be covered for at least the first ninety (90) days by the workers’ compensation carrier. 

What is a panel provider?

When you suffer a work injury and report it to your employer, they should provide you with a list of “panel providers” for you to choose where to treat for the work injury. This list should have also been provided to you when you were hired. If you have not been provided with a list of panel providers, then you are free to treat your injury with whomever you want and the workers’ compensation carrier should still pay the bills.

In the workers’ compensation process, it is not unusual for there to be instances where there are issues with the medical bills either being sent improperly or with the treatment being covered. Medical providers must not only send the bills, but also the medical notes or reports supporting the treatment and also Health Care Financing Administration (HCFA) 1500 Claim Forms in order for the treatment to be considered to be covered.

The workers’ compensation carrier has thirty (30) days from the receipt of the bill(s) to either accept and pay the bills at a repriced amount, deny them, or have a Utilization Review done on the bills if they feel that they are not reasonable or necessary. 

If you are receiving wage loss and/or medical benefits from workers’ compensation, or you are trying to receive such benefits through workers’ compensation court, there typically comes a time when you may want to settle your case for a lump sum amount. It is advisable to have a certified workers’ compensation specialist attorney represent you for the negotiation and actual settlement of your case. As part of the negotiations, you will want to have any and/or all medical bills incurred because of your work injury paid as part of the settlement, so that you don’t get stuck with those bills.

To do your due diligence, contact your medical providers to make certain that their bills have been submitted properly and that they have been paid by the workers’ compensation carrier. The last thing you want is to be surprised weeks or months after your settlement with medical bills coming to your door! By double-checking with all of your providers prior to the settlement, you can ensure that all parties are aware of the bills involved and that proper steps are being taken to get the bills paid. Once you settle your workers’ compensation case, you cannot go back to your employer and/or the workers’ compensation carrier to have them pay any outstanding bills for your workers’ compensation claim.

In order to not get stuck with medical bills, be sure to gather ALL your work injury related medical bills for your settlement negotiation.