How Do Worker's Compensation Fee Schedules Work?
When you are injured on the job, you may be entitled to collect certain benefits through workers' compensation. An important part of managing your workers' compensation claim is understanding how workers' compensation fee schedules work. This complicated process can be fraught with obstacles and delays.
Our experienced team offers free consultations to prospective clients struggling to understand the workers' compensation process. Learn more about understanding the workers' compensation fee schedule from the experienced workers' compensation attorneys at Dolman Law Group Accident Injury Lawyers, PA. We look forward to answering any questions you may have about fee schedules and how to navigate the Florida workers' compensation process.
What Is a Workers' Compensation Fee Schedule?
In Florida, employers who have more than four employees are required to carry workers' compensation insurance. Any employer who hires construction workers is required to carry coverage for all employees, even if there are fewer than four. Other employers may not need to carry coverage, but in general, most employers must do so.
What this means for you is that the vast majority of Florida employers will use workers' comp insurance that involves a fee schedule. A workers' compensation fee schedule is a tool individual states use, and it tells providers the maximum amount they can charge for a service when they are dealing with individuals covered under workers' compensation insurance. While there is a broader manual for this, most states, including Florida, have their own fee schedule.
The schedule explicitly defines the maximum amount a provider may charge for all procedures related to the injured person's treatment. While a provider may charge less than the amount offered, they can only charge a larger amount when they can provide proof the additional costs are justified. This can lead to conflicts with the insurance company that carries your workers' compensation policy.
Common Causes of Workplace Accident Injuries
Workplace accidents can occur in any industry. They may be related to a single incident or cause injury over time. According to the National Safety Council (NSC) the three top accidents suffered on the job include the following issues.
Overexertion Can Lead to Serious Workplace Injuries
In general, overexertion can be caused by constantly having to pick up heavy items on the job or engaging in a repetitive task. This can mean workers who are working on computers all day long and have repetitive stress injuries, such as carpal tunnel syndrome, are classified as overexertion. Workers who are in an environment that requires them to constantly bend to pick up packages or boxes would fall into this category as well. More than one-third of all workplace injuries occur in this category.
Contact with Objects and Equipment May Result in Workplace Injuries
These victims can suffer serious injuries to their backs, head, or limbs. More than one-quarter of all workers' compensation claims happen as a result of being struck by a piece of equipment, or against a piece. While this may sound obtuse, think about bending over and picking up something on the floor and striking your head against a table when you stand up. This type of injury can often happen in an industrial setting when the victim hits their head on a piece of large equipment.
Other types of injuries included in this category are crushing injuries where a victim has something fall on them, or when they are forced against a wall or other unmovable surface because of a forklift error. Slightly more than one-quarter of all workplace injuries are in this category.
Slip, Trip, and Fall Accidents Are Leading Causes of Workplace Injuries
Slip, trip, and fall accidents can occur anywhere on a job site. This could involve a victim falling from a ladder, a scaffolding, tripping over misplaced tools, or work-site supplies, or falling down a flight of stairs. Nearly 27 percent of all workplace accidents are a result of slips, trips, and falls. These types of accidents cause a variety of injuries from minor contusions to head injuries. Victims could require several weeks or months of medical care and treatment.
As you can judge from the most common workplace injuries, victims often must see multiple doctors, undergo rehabilitation treatment, and are likely to lose time from work. The entire process can be cumbersome for injured workers and their doctors. In the case of a workers' compensation claim, providers who are treating victims must be aware of the fee schedules. A doctor cannot simply refer a patient off to another specialist without first getting approval for the referral. In addition to the restrictions on referrals, doctors who are treating victims who are injured in the job can only bill a specific amount for the injuries. Let's look at some of the potential injuries and the reimbursement policies for each.
Reimbursement Policies Under Workers' Compensation Fee Schedules
Before you can determine the extent of an injury you suffer on the job, you will require an evaluation by a physician. According to Florida Health Price Finder, you will go through multiple steps, as follows:
- Evaluation by a physician - On average, this visit will cost about $77
- X-ray examination - On average, x-rays on the back will cost $69
- Six visits with a chiropractor - You can estimate this will cost about $197
- One steroid injection - Should this be required for pain, the cost will be $2,567
- Physical therapy - To help you recover from a back injury $467
As you can see, these procedures assume your back injury does not require surgery. This also means the total cost of these basic care needs will be approximately $3,377. However, reimbursement via the workers' compensation fee schedules will likely be far less than this. Doctors who are treating victims of workplace injuries have agreed to do so based on specific costs established by the state.
Before being reimbursed for expenses, a doctor must use a complex schedule that includes each individual component of your treatment. The Florida Workers' Compensation Fee Schedule manual includes over 200 pages of codes that doctors must adhere to.
Each individual service has a “cap” on the amount the doctor may charge for their services. This includes services like the use of an anesthesiologist, nurse practitioner, and use of equipment like braces. Additionally, these doctors agree to work with patients knowing they must adhere to the schedule. As a victim of a workplace accident, you have few options when it comes to which doctor to see, although you can request one change per cycle.
Workers' Compensation Insurance Covers Many Types of Medical Expenses
When you are injured on the job, the last thing you are probably thinking about is the amount a doctor is going to be reimbursed for their services. You can rest assured that you do not have to make a copayment on any treatments you receive. Due to the complex rules that surround workers' compensation treatments, the carrier who holds your employer's insurance is responsible for all your medical expenses.
Examples of Workers Compensation Medical Expenses:
- Emergency care: If you are rushed to the hospital via ambulance and seen in an emergency room, this care is fully reimbursed. However, once you have been admitted, the hospital may have to transfer your care to a doctor other than your personal care physician for treatment.
- Tests and X-rays: Depending on your injuries, the doctor may have to order specific tests like MRIs or x-rays. These tests must be preapproved by the insurance carrier and the amount the facility will be reimbursed will vary depending on the type of test, the county in which your treatment occurs, and the reason for the test.
- Pain control meds: If you are prescribed pain control medications for a back injury, you may face challenges picking up your meds at your preferred pharmacy. Some pharmacies do not cover workers' compensation insurance prescriptions. Additionally, per the guidelines set out by the Department of Labor (DOL) and using the Florida workers' compensation fee schedule, the doctor may be limited as to what drugs may be prescribed.
- Physical therapy: If your treatment regimen includes physical therapy the reimbursement to the therapist will be far lower than normal reimbursements under most private or state-offered insurance policies. To submit payments under the Workers' Compensation fee schedule the company would have to first get approvals to offer the therapy, then they are mandated to accept the fees paid under the WC policy.
- Surgical procedures: If you suffer an injury that requires surgical intervention, doctors are going to have to break down each component of your bill when dealing with workers' compensation. Under the fee schedule, they will have to break out the anesthesia, cost of the operating room, cost of the room in a medical/surgical unit, doctors' costs, the cost of nursing care, etc. Again, keep in mind, that the final bill submitted for reimbursement by your case team could take a considerable amount of time.
Workers' Compensation Laws Can Be Complex
The workers' compensation fee schedule is complicated, and this is one reason why you must keep track of each procedure and each doctor's visit. Unfortunately, calculating medical expenses is just one of many issues that can arise when attempting to observe workers' compensation rules.
For example, one of the challenges many workers complain about is the difficulty of purchasing prescription medications at a pharmacy of their choice. That is because Section 440.13 (3)(j), Florida Statutes a pharmacy need not participate in the Workers' Compensation program that requires them to abide by a fee schedule.
You may be frustrated with the amount of information that you are being inundated with, as well as the inconvenient or confusing stipulations of workers' compensation policy. That is understandable. This is one of the reasons why you may wish to consider speaking with an experienced workers' compensation attorney immediately following a workplace injury.
Use Caution if You Are Offered a Workers' Compensation Settlement
You may think if you are offered a sizable settlement that you should quickly accept it. Be very careful. Once you accept an offer under workers' compensation, you will be on your own for any medical expenses that are incurred once that offer has been accepted. In fact, an insurance company may make an offer in the hopes of minimizing the costs they are paying out for your medical bills.
While the chances are very high they are paying less than “standard” fees for your treatment from a work-related injury, they are also aware that long-term treatment is going to cost them even more. Remember, when you are in a car accident or other type of accident, chances are the insurance company is going to pay full medical bills, regardless of the amount. In fact, in most cases you will use your personal insurance.
That means you decide which doctor to see and where you purchase your prescription medications. Also, your doctor will determine the course of treatment to make sure you make as full a recovery as possible. With workers' compensation claims, all medical bills, prescription drugs, and treatments must be approved before your treatment commences, which could slow down your recovery.
Confused About Workers' Compensation? Do Not Give Up
If all of this information leaves you confused, do not worry. Insurance companies are hoping you are confused. That means they can limit their exposure if you do not know what questions to ask, or what your rights are. Due to the fact that most people do not know what questions to ask, or what rights they have under workers' compensation rules, they are liable to agree to things they would not agree to under “normal” circumstances.
There are likely many factors of a workers' compensation claim you are unfamiliar with, and that is fully understandable. This is why after you have reported your injury to your employer, you should seek out guidance from an experienced personal injury lawyer who understands Florida workers' compensation laws. Whether your claim has been denied, a doctor has told you they wish to provide a specific service that has been denied, or you have been informed your benefits are going to expire, it's important to speak with an experienced workers' compensation attorney to make sure you have someone advocating on your behalf.
Remember, workers' compensation insurance companies have a team of attorneys to help them justify their actions, particularly when they are denying claims, or determining the victim is no longer eligible for benefits. You should expect the best level of care, regardless of what the insurance company is requiring from the doctor. Just because the doctors are limited to how they charge for treatment under the Florida Workers' Compensation fee schedule does not mean you should suffer the repercussions in your treatment.
Why Should I Choose Dolman Law Group to Represent Me in a Workers' Compensation Claim?
Dolman Law Group employs a team of highly skilled workers' compensation attorneys who will work diligently to reach a fair resolution to your claim. We have over a decade of experience serving injured workers' across Florida. During this time, we have been repeatedly recognized for our negotiating skills and legal insight by our colleagues and clients.
A few of our recent successes include:
- a 5 million dollar settlement for a car accident client with burn injuries
- a 6.7. million dollar wrongful death settlement
- a 3.2 million truck accident settlement for a client with a brain injury
As one of Florida's leading personal injury law firms, we are known for our attention to detail, strong work ethic, and dedication to our clients' needs. Dolman Law Group clients know that they come first. For more insight into the kind of treatment you will receive, we encourage you to take a look at testimonials from former clients.
Contact Dolman Law Group For Help With Your Florida Workers' Compensation Claim
You have rights when you are injured at work. Regardless of what type of injury or illness you have as a result of being on the job, you are entitled to the best possible care to ensure you recover fully, and if possible, return to your job. Although the process can be intimidating, you should be able to make sure your expenses are covered.
Do not let the barriers you reach while dealing with a workplace injury stop you. Instead, contact a workers' compensation attorney and let them guide you through this difficult process. A Florida workers' compensation lawyer can answer your questions and work to ensure you can afford the medical care you deserve. Our team can help you negotiate an appropriate settlement and take your claim to court if required.
Dolman Law Group Accident Injury Lawyers, PA offers free consultations to those who have suffered injuries at work and are having trouble seeking compensation for the damages they suffered as a result. To contact Dolman Law Group Accident Injury Lawyers about a consultation on your case you can either call our Clearwater office at (727) 451-6900 or fill out a contact form online.
Dolman Law Group Accident Injury Lawyers, PA
800 N Belcher Rd
Clearwater, FL 33765