Why am I receiving unpaid medical bills in my Pennsylvania workers’ comp case?

Why am I receiving medical bills in the mail when I was injured at work? There are several potential answers to that question.

Under the Pennsylvania’s Workers’ Compensation Act, most injured workers are entitled to certain benefits. One of those benefits is medical care and treatment. Covered medical treatment can include doctor visits, physical therapy, occupational therapy, work hardening therapy, medication, lab and diagnostic tests, surgery, pain management, rehabilitation services, and more. Additionally, it is important to know that there are no ceilings or caps on dollar amount for treatment.

There are times that injured workers begin receiving unpaid medical bills in the mail. What could cause that? A few things.

  1. Your workers’ compensation claim may have been denied. An insurance carrier has 20 days from the date of injury to accept or deny a claim. If your claim has been denied, then you must file a claim petition which sends your claim into litigation. Remember, the burden of proof for a claim petition is on the injured worker to prove the case. That process is explained in detail here. Essentially, you will have to fight for your benefits. It is also important that when you settle your workers compensation case, that you have an experienced workers compensation attorney involved, not just to be sure you maximize your lump sum settlement, but also that unpaid medical bills are addressed. If not, you will be stuck with them. During litigation, an attorney can help get unpaid medical bills paid by private health insurance or arrange for non-collection during litigation.
  2. The insurance company may have challenged the medical treatment as not necessary or unreasonable. That is done through a process called utilization review.
  3. The Workers’ Compensation Act is specific how medical providers are to submit medical bills to insurance carrier for payment. If a medical provider does not properly submit the medical bills, the insurance carrier will deny payment. Likewise, some medical providers simply fail to submit them at all or are unware of workers compensation insurance information.
  4. Sometimes medical bills are not paid simply because of a mistake by the insurance carrier.
  5. Medical treatment occurs overtime, the condition worsens or diagnostic testing determine a much greater extent to the work related injury than the insurance carrier accepted At that point, a Review Petition would have to be filed and litigated to expand the accepted injury description. It is common for insurance carrier to attempt to limit the description of injury and therefore the medical treatment.

Nevertheless, unpaid medical bills can rack up to a significant amount of money. They can also have a negative financial impact on a claimant because many times these unpaid medical bills are turned over to collections which impacts the claimant’s credit score.

Additionally, is some circumstances, unpaid medical bills can lead to potential penalties against the insurance carriers. Medical treatment, diagnosis, and medical bills are some of the more complex issues that arise throughout a workers’ compensation claim. Medical treatment and bills often lead to litigation. The litigation process is complicated and can be frustrating. While you are trying to recover from the physical and mental toll of a work-related injury the last thing you want to deal with is unpaid medical bills. That is why you need an experienced workers’ compensation attorney who knows Pennsylvania workers compensation law to help you.

If you have suffered a work injury, call Mooney Law today for an absolutely FREE consultation. We know Pennsylvania workers’ compensation law and can help guide you through the complex process.  Our firm litigates workers compensation cases all the time.  We have collected tens of million in benefits for injured workers throughout Pennsylvania.  Call today at 717-200-HELP or 717-632-4656.  Visit Mooney4Law.com.

Mark Buterbaugh

Attorney representing injured workers and Social Security Disability clients in Pennsylvania and Maryland.