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Denied Medical Bill Lawyer

When you file a claim for workers’ compensation after an on-the-job injury, you should receive medical care without being charged any co-pay or other costs by your doctor’s office. Your treatment is covered by workers’ compensation regardless of what kind of health insurance you have or whether you have insurance at all. The doctor’s office submits its bills directly to your employer’s workers’ compensation insurance carrier, so you are not out-of-pocket one dime for your treatment.

Once the bills have been submitted, the insurance company has 30 days to either accept or deny the doctor’s bills. If bills are denied or payment is delayed, the Figured Law Firm can help. Our experienced workers’ compensation lawyer will go to work right away to make sure your doctor gets paid and that you don’t have to suffer any lapse in treatment because of the insurance company’s actions.

How bills get denied

Medical care is covered by workers’ compensation so long as it is reasonable, necessary and related to treatment of the work injury. Insurance companies may deny bills, therefore, on the grounds that the treatment was unreasonable, unnecessary or unrelated to treatment of the work injury. Once bills are submitted, the carrier has 30 days to deny the bills or face a possible penalty for delayed payment.

A denial of the bills by the carrier triggers the Utilization Review (UR) process. Under this procedure, an independent doctor, the UR provider, will review your medical records and talk to your doctor. You’ll likely be asked to provide a written statement as well. At the end of the Utilization Review, the provider will make a determination about whether the doctor’s bills are reasonable and necessary. If the provider determines the bills are unreasonable or unnecessary, we can help you appeal the decision to the Workers’ Compensation Appeal Board (WCAB). The insurance carrier can also appeal if the provider deems the bills should be paid. The carrier will nevertheless need to pay the disputed bills even while the appeal is pending.

When the carrier neither accepts nor denies your medical bills

Sometimes the insurance company may fail to either accept or deny the doctor’s medical bills within the required 30-day period. Although different than a denial, the failure to respond can negatively impact your care. The bills have not been expressly denied, triggering Utilization Review, but your doctor is still not getting paid and may refuse to continue treating you until payment is made. In this situation, the Figured Law Firm will work with your doctor and take action as needed to ensure you continue to get treated and that your doctor gets paid. We can negotiate directly with your doctor and/or take action against the insurer, such as by filing a penalty petition with the Board of Workers’ Compensation (BWC) for delayed payment.

Call the Figured Law Firm for Help with Denied Medical Bills in Pennsylvania Workers’ Compensation

For help with denied medical bills or other issues that are delaying your treatment or keeping you from getting medical care after an on-the-job injury in eastern Pennsylvania, call the Figured Law Firm at 570-954-9299 for a free consultation with an experienced and successful Pennsylvania workers’ compensation attorney.

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