Responding to a posting elsewhere, Arizona Attorney Theodore Ronca, writes at http://blog.reduceyourworkerscomp.com/2012/07/fix-workers-comp-misunderstandings-before-they-get-out-of-hand/?utm_source=rss&utm_medium=rss&utm_campaign=fix-workers-comp-misunderstandings-before-they-get-out-of-hand#axzz20nxdNdu5 that employers should address misunderstandings before things get out of hand. Mr. Ronca is absolutely correct, that it is usually left to the employer to pick up the pieces, figure out what someone else missed and, in the process, pay for the privilege. The specific scenario he discussed involved an out of state injury in which the injured worker received medical treatment from an out of state medical provider. When the medical treatment was not paid, presumably, the medical provider sent "kind reminders" to the injured worker demanding payment. When the bills were not paid, the worker complained to a site that dealt with complaints against insurance companies and was recommended to file a complaint with the relevent workers compensation board. Mr. Ronca's article necessarily leaves out a few details as those details were not really the point of his post. There was, however a comment in his article from the insurance carrier that, when contacted, the bills in question had never been previously submitted. In re-reading the article, one is left to surmise whether the Insurance Carrier knew any of this was going on, including the recommendation that a complaint be filed with the Workers' Compensation Commission.
It may seem hard to believe, but your average comp adjuster doesn't have spare time on their hands to go out and look for bills to pay. Usually, the adjuster gets the bills or some cryptic portion of them and then tries to find the relevent information necessary to connect it to that adjuster's files and then to determine if the information is there to show that the medical expense is compensable. The problem usually lies not with the adjuster but with the information provided to the medical provider by the injured worker. Face it, this worker is out of state has an injury and goes somewhere for emergency care. What are the chances that the injured worker a) knew the information to provide b) actually informed the medical provider that the condition was related to work or c) told the provider where to send the bills. The chances are not good that the employer or their carrier had ever seen the bill in the first place. For that matter, is the "bill" actually the bill for the treatment or just a past due notice referring to previous unknown and unseen charges. Once the employer and the insurer know about the unpaid medical expense, what next? Once knowledge of the bill is given, payment is not imminent without proper bills or the medical records upon which the bills are based. Most medical providers are proficient at sending the medical bills but jealously guard the medical note since, after all, privacy issues are involved. The WC adjuster is not going to pay a bill for treatment they've never reviewed so a request for the medical records is next. Under Georgia law, the medical record is not confidential to the party responsible for payment and yet, most medical providers insist on a medical release so that they can cover their liability concerns. This adds unbelievable amounts of time to the bill paying process since the negotiation over whether a release is required, whether the employee is actually cooperating in providing that medical release (at least under Ga Law, if the medical provider requires by its rules that a medical release be provided, the medical provider is responsible for obtaining the same at the time of treatment.). So long before the poor adjuster has ever seen the bill the medical provider and the injured worker have already missed a couple of steps and yet it is now the Adjuster's fault for the delay in paying a bill. Nevermind the fact that by this time a collection agent is involved and that collection agent has neither the original bill (with the CPT, DRG coding as opposed to the past due notice with a bottom line figure) nor the medical record which are both prerequisites to payment. No, the default assumption is that the person with the checkbook is simply trying to hold onto the cash, skip out on payment to the provider or to destroy the Employee's stellar credit rating.
Multiple steps were missed before the adjuster ever knew anything about the bill at hand. Multiple steps were then necessitated on the part of this adjuster to find out what, who, when and how much. All of these steps were not because of any fault on the part of the adjuster, so would it be too much to ask that instead of a complaint, someone simply say "thank you" when the adjuster finishes cleaning up someone else's mess?
"Skedsvold & White
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