Question: ?I am a doctor. My patient was injured on the job and his workers? compensation insurance paid for a little while. Now they have been denying bills after ?utilization review?. The patient?s attorney isn?t doing anything to get the bills paid. Can I go after the workers? compensation insurance company myself to get paid?
Answer:? Yes.?Medical providers have a right to file a petition for compensation due in any case where payment of medical bills is being contested. The issue is addressed several times in Title 19 of the Delaware Code. ?For example, Title 19 Del.C. ? 2346 provides:
If any person charged with the payment of medical and other services and the provider to whom said payment is due fail to reach an agreement in regard to such charges, any interested party may notify the Department of the facts. The Department shall thereupon notice the time and place of hearing sent by certified mail to all parties in interest.?
Also, 19 Del.C. ? 2348(b) states as follows:
(b) In a controversy as to the responsibility of an employer or the employer?s insurance carrier for the payment of compensation and other benefits under Part II of this title [Part II includes medicals], any party in interest may petition the Board in writing for a hearing and award. The petition shall be sent to the Department?s offices in Wilmington and shall set forth the reason for requesting the hearing and questions in dispute which the applicant expects to be resolved.
There is a 45 day rule for appeals from Utilization Review denials, but there is also a Superior Court case invalidating that rule because it conflicts with the 2 year/5 year statute of limitations on workers? compensation claims found in the Delaware Code. ?The case dealing with that issue was Avila-Hernandez, C.A. No. N10A-06-002 DCS (Jan. 6, 2012).?(Please note: Avila-Hernandez is currently on appeal in the Delaware Supreme Court. As of the time of this blog post, en banc oral argument is scheduled for November 14, 2012 at 2 pm.)
If you end up testifying in support of the treatment and charges, then you may be able to recover a fee for your time in testifying. 19 Del.C. ? 2322(e) states, ?[t]he fees of medical witnesses testifying at hearings before the Industrial Accident Board in behalf of an injured employee shall be taxed as a cost to the employer or the employer?s insurance carrier in the event the injured employee receives an award.?
If you win your case for medical bills, you may be able to also collect an award of statutory interest. 19 Del.C. ? 2322F(h) states that ?[u]npaid invoices shall incur interest at a rate of 1% per month payable to the provider.?
In conclusion, the Delaware new workers? compensation laws appear to make it possible for medical providers to pursue claims directly before the Industrial Accident Board for medicals that are not paid by their patients? workers? compensation carriers.
Ben
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If you are a medical provider and would like to discuss medical reimbursements in automobile accident or workers? compensation cases with Ben, please email him directly at ben.schwartz@schwartzandschwartz.com.
Source: http://www.schwartzandschwartz.com/medical-providers-pursue-workers-compensation-claims-delaware/
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