Who Will Pay My Medical Bills?

If you received an injury by accident arising out of and in the course of your employment, then you probably have a workers’ compensation claim. If so, your employer is required to pay for certain medical care and treatment. If your employer or their insurer refuses to pay for medical care which meets the following criteria, you should contact a lawyer at Burnside Law Firm LLP for assistance in submitting a workers’ compensation claim.

Before your employer can be held responsible, you must establish that the medical care is reasonably related to your on the job injury. The care must also be prescribed by an authorized treating physician. “Authorized” status generally applies to doctors selected from the employer’s posted panel of physicians, agreed upon by employee and employer or a doctor you were referred to by your authorized treating physician. One exception to this rule is for emergency care resulting from unforeseen circumstances which call for immediate action. The employer is generally required to pay for emergency care. See O.C.G.A. 34-9-200(d)

The medical care must also be reasonably necessary. This means it must be “reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.” See O.C.G.A. 34-9-200(a)

Medical bills for your care should then be submitted to the employer or employer’s insurer in the proper way. This requires submission of certain forms and records. Fortunately, this is usually handled by the doctor’s office. See O.C.G.A. 34-9-205 and Board Rule 205.

Once the care is authorized and the bill is properly submitted, the employer is only required to pay the “usual and customary charge” for the services rendered. Usual and customary charges are generally outlined in a “Fee Schedule” published by the Georgia State Board of Workers’ Compensation. Most doctors are familiar with the Fee Schedule and seek prior approval and authorization before rendering care. Where the doctor accepts payment in accordance with the Fee Schedule, they are not permitted to bill you for any additional amount. Bills for services not listed on the Fee Schedule, can be contested by the employer and submitted to peer review to determine if they are “usual and customary.”

If you have been injured on the job and wish to learn more about the medical bills your employer is required to pay, contact one of the experienced attorneys at Burnside Law Firm LLP for a free initial consultation.

Disclaimer: Every worker’s compensation case has its own unique facts and circumstances. The information above is a general description of the issues presented and should not be relied upon as legal advice in your case. For specific legal advice, contact one of the lawyers at Burnside Law Firm LLP.

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