Why Am I Receiving Medical Bills in My Alabama Workers Compensation Case?

Why Am I Receiving Medical Bills in My Alabama Workers Compensation Case?

One of the most common questions we hear from injured workers is “If workers’ compensation is supposed to pay my medical bills, why am I receiving collection notices and bills from doctors?”

The answer depends on the circumstances, but the good news is that receiving a bill does not automatically mean you are responsible for paying it.  In fact, Alabama’s Workers’ Compensation Act generally provides that the employer shall pay for all reasonable, necessary, and authorized medical treatment related to a compensable work injury.

So why do bills still show up?

The General Rule: Workers’ Compensation Should Pay for Authorized Treatment

If your injury is covered under Alabama’s Workers’ Compensation Act, your employer (through its workers’ compensation insurance carrier) is generally responsible for paying for: doctor visits, hospital treatment, surgery, physical therapy, prescription medication, diagnostic testing, medical equipment, mileage reimbursement for trips back and forth to see a doctor, therapist or to pick up your medication-provided that the treatment is:

• related to the work injury
• reasonably necessary
• and properly authorized

When everything works as it should, the medical provider bills the workers’ compensation insurance carrier directly and the injured worker receives no bill at all.  Unfortunately, things do not always work as they should.

Reason #1: The Medical Provider Doesn’t Realize It Is a Workers Compensation Claim

This is perhaps the most common explanation that we see.  Sometimes a medical provider mistakenly submits the bill to the injured workers’ personal health insurance carrier or directly to the injure worker instead of the workers’ compensation insurance carrier.

Mistakes happen, and while it can be frustrating, this reason is one that typically is easy to correct.

Reason #2: The Workers’ Compensation Carrier Has Not Processed the Bill Yet

Sometimes the treatment has been authorized, but payment is simply delayed.  Large medical providers often generate billing notices automatically before the insurance company has completed processing the charges. In these situations, the bill may be more of an accounting issue than an actual dispute-and again, this issue is generally not too difficulty to rectify.

Reason #3: The Insurance Carrier Is Disputing the Treatment

Occasionally, the workers’ compensation carrier may argue that the treatment was not authorized, the treatment was unrelated to the work injury or the treatment was not medically necessary.

When this happens, the medical provider may begin sending bills directly to the patient while the dispute remains unresolved, and in such situations, the help of an experienced Alabama workers compensation attorney may be invaluable.

Reason #4: Treatment Was Obtained Outside the Authorized Medical System

One of the most important concepts in Alabama workers’ compensation law is the Authorized Treating Physician. Generally speaking, the employer controls medical treatment through the authorized treating physician and approved referrals, and if an injured worker independently seeks treatment from a physician who was not authorized, the workers’ compensation carrier may refuse payment.

There are exceptions to this rule, particularly when the employer neglects or refuses to provide necessary medical treatment, but those situations can become legally complex.

Should I Pay the Bill?

In most situations involving authorized treatment for a compensable injury, injured workers should be cautious before paying medical bills out of pocket, and should not do so in my opinion until any questions are answered as to why treatment has not been paid.

What If the Bill Goes to Collections?

Receiving a collection notice can be frightening. If a bill relates to treatment that should have been covered under workers’ compensation, it is important to address the issue promptly.

Keep copies of:

• all bills
• collection notices
• explanation of benefits forms
• correspondence from the provider

These documents may become important if there is a dispute regarding payment responsibility.  And not to sound like a broken record-if this happens in your Alabama workers’ compensation claim, you should avail yourself to the advice of an experienced Alabama workers compensation lawyer.

At Powell and Denny, we have spent decades helping injured workers obtain the medical treatment and benefits they are entitled to receive under Alabama law.

If you have suffered a job injury and you have questions about your rights and benefits under Alabama’s workers compensation laws -don’t hesitate to contact and speak with one of the experienced Alabama Workers Compensation and Social Security Disability attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.  Powell and Denny would appreciate the opportunity to help.  And remember, there is no fee unless you win.

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