Attorney Marc Perper (As published in The Herald News, Ask an Attorney)

The financial burden of medicals bills associated with an on-the-job injury has been greatly reduced if Workers’ Compensation coverage is available. Here’s how the new changes work.

In the past, injured workers faced two significant burdens relating to the mechanics of their medical bills. For some, the difficulty was slow or delayed payments of medical bills themselves, often hampering an injured workers’ ability to continue receiving care. The penalties associated with non-payment of medical bills were low and rarely enforced.

Perhaps more significant and widespread was the relationship between the “allowed” medical expenses and the fees actually charged for care, including office visits, routine labs and x-rays, and more intensive therapies.

While a treating physician might charge $100 for an examination, the allowed medical benefit was often substantially lower. Often, the difference between what was charged and the amount actually paid by employers or their workers compensation insurance carriers was unfairly billed to the injured worker. As bills piled up, injured workers with no means to pay were often subjected to harassing calls from collection agencies, poor credit ratings and even collection lawsuits.

Under the new law, medical bills are subject to a fee schedule.   If the treatment is covered under workers’ compensation, physicians and hospital providers may charge no more than the scheduled fee or a fee negotiated with the employer’s workers’ compensation insurance carrier, whichever is greater. Injured workers can no longer be held liable for charges above the allowed amount when provided care is in accordance with the guidelines of the Workers Compensation Act.  If the medical provider processes a bill through the employee’s group health insurance instead of workers’ compensation, the patient can be held liable only for insurance deductibles or co-payments.

Furthermore, once informed of a workers’ compensation claim, all attempts by medical providers to seek payment for services from an injured worker must cease.  So long as the injured worker or his attorney furnishes regular case status reports to the medical provider, the provider may not place the bill in collection, file suit against the patient or report the unpaid bill to a credit bureau.  A medical provider can collect on an unpaid bill only if the Illinois Workers’ Compensation Commission – the court that hears workers’ compensation cases – finds that the employer is not liable for that particular bill or treatment.

Delaying payments of medical bills for injured workers now also carries an increased penalty if there is no legal basis to justify the delay in payment.

The creation of a standardized fee schedule coupled with increased penalties for those who delay payment will help to protect injured workers and their families from critical financial loss.  Taking injured workers out of the “food chain” as it relates to collections for medical services further reduces the emotional stress endured by injured workers and their families.