“Renting” a Workers’ Compensation Claim and Payment of Medical Bills
After given timely notice of a work-related injury, a supervisor must then notify its workers’ compensation insurance company of the claim. The adjuster assigned to the case is required by the Workers’ Compensation Act to conduct an investigation and within 21 days either formally accept responsibility for paying wage loss and/or medical benefits (via a Notice of Compensation Payable “NCP”), deny liability (by issuing a Notice of Denial), or temporarily accept liability (by issuing a Temporary Notice of Compensation Payable or “TNCP”). Note that a TNCP can be withdrawn by the insurance company anytime within 90 days of the date of injury, accompanied by a Notice of Denial, and benefits will stop as of the date of that notice. However, if the TNCP is not stopped within the 90 days, it converts to a NCP and the claim is fully accepted. If a claim is denied, a TNCP is stopped, or if the claim is only accepted for payment of medical bills (via a Medical Only NCP) and there is a wage loss (total or partial), a Claim Petition must be filed and the case litigated before a workers’ compensation judge.
Many times, an insurance company will simply “rent” a claim instead of formally accepting responsibility for it by filing the proper documents with the Bureau of Workers’ Compensation. The insurance company may pay medical bills and then try to direct an injured worker to treat with panel physicians who is a physician approved by the employer to treat work related injuries. When this happens, injured workers are led to believe that the injury has been officially recognized and accepted for payment of wage loss and/or medical benefits. This is not the case. If the formal acceptance documents are not filed, the claim has not been accepted even though medical bills have been paid. This false sense of security has set many injured workers back significantly, believing that if the bills are being paid that they will continue to be paid. Without formal acceptance of the claim, the insurance company can at any time stop paying medical bills, leaving the injured worker with outstanding bills from medical providers seeking payment from the worker.
The General Assembly, in enacting the Workers’ Compensation Act, specifically provided insurance companies with the ability to pay medical bills without admitting responsibility for the work injury. This is sometimes not a big problem if the injury is very minor and there is no wage loss, i.e. a small cut, a bruise, or a sprained finger. However, if the injury causes wage loss or requires ongoing medical treatment (or the potential for treatment in the future) it must be formally recognized by the proper documents. There are many cases were one believed they merely suffered a sprain or strain and found out that the injury was really a tear or herniated disc after imaging studies are obtained and surgery is required. If the injury is not formally recognized, even after months of the insurance company paying medical benefits, the proposed surgery or medication prescribed almost always gets rejected for payment and the injured worker is at square one. The key is: don’t let the insurance company “rent” your work injury until it decides to stop and leave you out of work, losing wages, and are then unable to get medical treatment you need. Contact an attorney specializing in workers’ compensation whenever a work injury takes place and be advised of your rights.