Still getting medical bills after going to court and winning a workers’ compensation case?

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Getting a collection notice for a bill that was ordered to be paid by a judge is like a bad horror movie sequel

How can an injured worker go to trial, have the court order payment of disputed medical bills, have their employer pay the bills they were ordered to pay, but still be receiving medical bills? It’s like a horror movie or franchise where you think the villain is dead but keeps coming back to life.

Here’s the why and how it can happen in Nebraska.

Neb. Rev. Stat. 48-120(8) allows the court to order that an employer can pay bills through the so-called fee schedule or that employers reimburse other payors. Those payors are either the injured worker or a health insurer that paid a bill that was part of the workers’ compensation case.

Recently I encountered a situation where the court ordered the employer to reimburse a health insurer who had paid some bills in a disputed workers’ compensation case. The employer paid the health insurer, but then the health insurer decided that since the expense was related to a work injury that they could reverse the payment they made to the provider originally.

So, the medical provider attempts to collect the balance from my client. My client was confused and upset because they were getting collection notices for a case where the court had ordered that medical bill to be paid.

What is the solution for the client in this situation? In Nebraska the most leverage a plaintiff would have would be the penalty and fee provisions under Neb. Rev. Stat. 48-125. Once the employee gets the bill, thy should send to their attorney who will put the employer on notice that the medical bill remains unpaid after it was awarded. That puts the onus on the employer to pay within 30 days or be subject to an award of attorney fees under 48-125.

Medical providers and third-party payors don’t have standing to litigate in the Nebraska Workers’ Compensation Court, so I question whether the Nebraska Workers’ Compensation Court would have jurisdiction over them or what relief it could order against them even if it did.

The employee could have a case directly against their health insurer for breach of contract. Since health insurance payments are wages under the Nebraska Wage Payment and Collection Act, there could be a cause of action under that law as well. But in a case of relatively small-time graft by a health insurer, it might not be worth an attorney’s time or even filing fees to bring a case.

The best prevention for this situation would be to have the court order that bills be paid directly to the provider under the fee schedule. But there isn’t any Nebraska case law about when to pay bills under the fee schedule or when a payor should be reimbursed. I’ve had employers balk at being asked to pay at the fee schedule rate rather than to reimburse a third-party payor. In cases involving Medicare and Medicaid the reimbursement rate is generally much less than the workers’ compensation fee schedule rate, so paying at the fee schedule means the employer pays out more.

Injured workers’ may also want the faster reimbursement afforded to them when the court orders an employer to pay them back for any out of pocket medical expenses. If bills are paid under the fee schedule, then medical providers have to reimburse other payors. This can delay repayment and unscrupulous providers may try to pocket payments or double bill workers compensation and health insurance and/or the injured worker.

In the last legislative session, Nebraska passed bills that going forward will limit the ability to collect medical bills that are related to a workers’ compensation claim. However those protections only extend throhg final adjudication of a case. In a case where a health insurer reversed payment to a provider when they had been reimbursed through workers’ compensation after an awarded case, a provider would be free to collect an unpaid balance.

 

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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