First, you should call a Certified Pennsylvania Work Comp Specialist for a free consult. I am happy to provide that to you promptly, and at no charge.
There can be many reasons why the insurer in a Pennsylvania Workers’ Compensation case may not be paying for medical bills. First, what is the controlling document? Usually, it is a Notice of Compensation Payable which describes the accepted injury. This controls until it is amended by Stipulation or Court Order. Many injured workers in Pennsylvania get lulled into a false sense of security thinking that the insurer knows their injury is a low back disc herniation, for example- when in reality, the Notice of Compensation Payable almost always says “low back strain” or “low back contusion”. This can be a technicality on which the insurer hangs it hat in taking the position that it is not obligated to pay for medical bills for treatment relating to a disc herniation. How is this remedied? Your PA Work Comp Attorney can file a Petition to Review to challenge and expand the accepted work-related diagnoses. The Petition gets assigned to a Work Comp Judge and litigation follows.
Another reason a medical bill in a Pennsylvania Work Comp case may be unpaid is because the provider may not have billed the treatment on the proper billing form. They must also send the corresponding treatment note along with the form and it must be within 30 days of the treatment. If any of these elements are not met, the insurer has no obligation to pay. Note that if an insurer pays part of a work-related treatment, the provider may not “balance bill” the injured worker- in other words, it cannot send the balance of the unpaid portion to the injured worker for payment. Its remedy here is called Fee Review.
In addition to a possible Petition to Review, the attorney may consider filing a Penalty Petition if it feels the nonpayment of the medical bill was in violation of the Pennsylvania Workers’ Compensation Act. However, if this issue is one of “causation”-meaning the insurer is claiming the diagnoses on the bills don’t match the accepted injury, then a Review Petition is the proper mechanism to challenge this.
Unpaid medical bills cause major stress and financial damage in many Pennsylvania Work Comp cases. The litigation process is slow but the collection efforts are fast. If you have unpaid medical bills, contact your PA Work Comp Lawyer immediately so he or she can investigate the reason why and take the appropriate steps to ameliorate the situation. If you do not have a PA Work Comp Attorney helping you, it is strongly recommended as 1) You pay nothing out of pocket, 2) Your case will be better positioned for a lump sum settlement, 3) Pennsylvania Workers’ Compensation has become highly complex, and 4) Litigation can be expensive and the attorney will cover the costs.
Michael W. Cardamone- Certified Specialist in Pennsylvania Workers’ Compensation.
The Cardamone Law Firm, LLC