If you are hurt on the job you may be entitled to workers compensation benefits in Virginia. The most important of all available benefits is the right to have your employer or its workers comp insurance carrier pay for medical treatment related to your work injury.
The Virginia Workers Compensation Act requires your employer to provide a physician and other necessary medical attention, free of charge, for as long as necessary after your accident. Covered medical treatment includes: ambulance services; hospitalizations; surgery; rehabilitation; medical equipment (i.e., canes, walkers, wheelchairs, prostheses); and, transportation to and from health care appointments.
But you only receive this treatment free of charge if you meet your burden of proving that the treatment for which you are seeking payment was related to your work accident. And because you have the burden of proof, the insurance carrier can dispute all or part of your medical bills.
Your medical providers want to get paid for their services. They may demand that you – the injured worker – pay the unpaid medical bills that should be covered through workers compensation. And if you don’t, the health care provider may turn over the unpaid medical bills for your work injury to collections.
Depending on the nature of your injury and the treatment required, your medical bills will add up quickly. You may receive unpaid medical bills and letters and telephone calls from debt collection agencies. This will increase your stress when you’re already trying to recover physically. And it will wreck your credit score if you ignore the unpaid bills from health care providers.
This article explains what to do when you start receiving letters and phone calls from health care providers and debt collection agencies over unpaid medical bills related to your work injury. And how to get the unpaid medical bills paid through workers comp.
Keep reading for more information. If you have additional questions, or are looking for a top-rated workers comp attorney in Virginia, call me for a free consultation: 804-251-1620 or 757-810-5614. I help injured workers in Virginia win their cases and negotiate workers compensation settlements that include the payment of all unpaid medical bills.
Are you receiving calls from hospitals, doctors, surgeons, diagnostic facilities, or therapists over unpaid medical bills for your work injuries?
Have your workers compensation doctors sent your unpaid medical bills to collections?
Has a debt collection agency filed a warrant in debt over unpaid health care provider bills?
If you answered yes to any of these questions, don’t panic. There is help available if you’re the victim of medical provider debt collection activities related to treatment for your work accident.
Filing a workers compensation claim in Virginia triggers Virginia Code Section 65.2-601.1. This is why filing a claim is one of the first things you should do after an accident at work.
Code section 65.2-601.1 is entitled “Effect of Filing Claim; Stay of Debt Collection Activities by Health Care Providers.” It states:
Whenever an employee makes a claim pursuant to Section 65.2-601, all health care providers, as defined in Section 8.01-581.1, shall refrain from all debt collection activities relating to medical treatment received by the employee on connection with such claim until an award is made on the employee’s claim pursuant to Section 65.2-704. The statute of limitations for collection of such debt shall be tolled during the period in which the applicable health care provider is required to refrain from debt collection activities …
Debt collection activities include repeatedly calling or writing you and threatening to turn your bills over to a debt collection agency or to an attorney for collection enforcement.
Routine billing or inquiries about the status of your workers’ comp claim are not considered debt collection activities.
Your credit should not be damaged because of unpaid medical bills related to your workers’ comp claim.
You must, however, be proactive to make sure that your credit score isn’t lowered because of these unpaid medical bills. If you’re not proactive, health care providers often will take action that harms your credit and impacts your financial future. A reduced credit score affects your ability to rent or buy a home or car.
The best course of action to deal with unpaid workers’ compensation bills depends on the procedural status of your claim:
After you file a workers comp claim you receive specific legal protections.
If you’re receiving medical bills and debt collection notices but haven’t filed a claim for benefits with the Workers Compensation Commission, file a claim immediately.
You do not get protection under Virginia Code Section 65.2-601.1 unless you filed a claim with the Commission. This is true even if you reported your work accident to the employer right away or have received benefits from the insurance carrier voluntarily.
If you have received a lifetime award of medical benefits for your work injury but health providers are sending you bills, you should do the following:
1. Send a copy of the medical bills to the claims adjuster and ask for payment. Send a courtesy copy of your letter to the insurance carrier to the health care provider seeking payment of the unpaid bills.
2. Send a debt collection stay letter to the health care provider or debt collection agency seeking payment.
3. File a change in condition claim with the Commission seeking payment of the outstanding medical bills. The Commission will decide if the insurance carrier is responsible for the entire amount of the unpaid medical bills, a specific portion, or none at all. Health care providers are bound by the Commission’s decision and must accept payment as ordered by the Commission.
Consider how you will pay for outstanding medical bills before settling your workers compensation case.
Does Your Settlement Cover the Payment of Medical Bills Through the Date of Approval?
If your settlement documents state that your employer and its workers comp insurance carrier are responsible for the payment of medical bills for services rendered through the date the Commission approves the settlement, and the medical bills are related to treatment you received before the case settled, then you should send a copy of the bills to the claims adjuster and ask for payment.
If the claims adjuster does not respond to your request, or says the insurance carrier will not pay, file a change in condition claim with the Commission.
The Commission has jurisdiction over claims for unpaid medical bills even if you have settled your case, as long as your settlement states the employer and insurer are responsible for the payment of medical bills through a certain date.
If your settlement documents state that you are responsible for the payment of outstanding medical bills that may arise, call an experienced workers comp attorney.
Your attorney may be able to negotiate a bill reduction so that you pocket more money.
Or your attorney may find that you have a defense available to the payment of the medical bills because of language included in the settlement documents or other statutes.
Balance billing, also called extra billing, is a practice used by some health care providers.
A health care providers is balance billing if it asks the patient to pay the difference between what the workers compensation insurance carrier reimbursed and what the health care provider chooses to charge.
Balance billing is not allowed under the Virginia Workers Compensation Act. Code Section 65.2-714(D) states:
No physician, hospital, or other health care provider as defined in § 8.01-581.1 shall balance bill an employee in connection with any medical treatment, services, appliances, or supplies furnished to the employee in connection with an injury for which (i) a claim has been filed with the Commission pursuant to § 65.2-601, (ii) payment has been made to the health care provider pursuant to § 65.2-605.1, or (iii) an award of compensation is made pursuant to § 65.2-704. For the purpose of this subsection, a health care provider “balance bills” whenever (a) an employer or the employer’s insurance carrier declines to pay all of the health care provider’s charge or fee and (b) the health care provider seeks payment of the balance from the employee. Nothing in this section shall prohibit a health care provider from using the practices permitted in § 65.2-601.1.
If your health care provider accepted partial payment from the workers compensation insurance carrier, it cannot send you a bill for the remaining amount of the medical bills.
Usually the debt collection stay letter and notice that a workers compensation claim is pending gets the health care provider’s attention and stops debt collection activities. But not always.
If the health care provider or collections agency continues to pursue debt collection over unpaid workers comp medical bills, then your attorney can file a motion with the Commission. The motion will ask the Commission to order the health care provider to stop unlawful debt collection activities.
If the health care provider violates the Commission’s order, you can ask for damages, including sanctions and attorney fees, for the health care provider’s violation of the workers comp statute addressing debt collection.
You may also have claims under federal debt collection laws.
There are several situations where an injured employee may have to pay for medical treatment related to a work injury.
First, you are responsible for the payment of medical bills if the Commission denies your initial claim for benefits and finds that your injuries are not compensable.
Second, you are responsible for the payment of medical bills if the Commission denies your claim seeking payment.
And third, you are responsible for the payment of medical bills if your workers compensation settlement does not state that the employer and its insurance carrier is responsible for them.
You may, however, have other payment options if the Commission denies your claim for benefits.
A workers compensation denial triggers the anti-subrogation statute in the Virginia Code. If the Commission denies your workers’ compensation claim then your private health insurance or other health care coverage will have to pay the medical bills. The health insurer cannot exclude coverage under your contract. Of course, this only helps if you have health insurance.
You have enough to deal with after a work-related injury. Don’t add to the stress of your physical and mental recovery by trying to take care of unpaid medical bill issues and fight health care providers on your own.
Call me today for a free consultation: 804-251-1620 or 757-810-5614. I’ve helped hundreds of injured workers in Richmond, Newport News, Virginia Beach, Roanoke, Harrisonburg, and Manassas get through the workers comp process. And I want to help you and your family during this difficult time.