Payment Of Medical Bills in a Workers Comp Case

Date: August 17, 2015
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Question: I injured my back at work 2 years ago. I was only out of work a few weeks and I was paid workers compensation for that time. I then settled my wage loss case for a lump sum. But the settlement deal included the understanding that the insurance carrier would continue to pay my medical expenses. Yesterday I went to my pharmacy to pick up some prescription back pills as my back pain was acting up. The pharmacy told me that the workers comp carrier is denying payment. Can they do that? J.G., Central Pa.

Answer: There are several instances where a carrier can deny payment for the treatment of an accepted work-related injury. One example is if there has been a judicial determination that you have fully and completely recovered. Another instance is where you have resolved all aspects of your claim, medical and wage loss, by way of a Compromise and Release Agreement. Also, the carrier can chose to contest payment of the bills by asserting that the bills are not causally related to your work injury. The carrier can also request a Utilization Review of the bills which asks that a health care practitioner be assigned by the Workers Compensation Bureau to assess whether the treatment is reasonable and necessary. Absent those circumstances, the insurance carrier runs the risk of being exposed to penalties if they simply deny a medical bill with no good reason to do so. Contact should be made with the workers comp insurance company to find out what is going on.

If you’ve suffered a work injury and have questions about your claim, contact me at tcummings@dlplaw.com or call (570) 347-1011 for a free consultation.

Tom Cummings
Thomas P. Cummings has been a Partner with Dougherty Leventhal & Price, LLP since 1996 and has been with the firm since 1991. He focuses his practice on workers’ compensation, Social Security Disability and personal injury cases.