Who Pays the Bill

KarenTN

Employee reports he injured his ankle at work. We set up appointment with panel doctor. Doctor says injury not work related. Work Comp insurance denies payment. Doctor's office is billing company, refusing to bill employee's regular health insurance. Employee says he is not responsible since we sent him to the doctor. My question--By authorizing the doctor's office to treat and bill to our workers compensation carrier, are we automatically accepting financial liability even if it is determined not to be work related?

John Phillips TN

No. You should send a letter to the health insurance carrier advising of the situation. If you have the doctor's medical records, send copies to the health insurance carrier with your letter. Send a copy of the letter to the doctor's billing clerk who is being uncooperative and to the w/c carrier. Be factual in what you say to the health insurance carrier. That is, don't say that this is not a w/c case, just that the medical treatment has occurred, the doctor has said whatever the doctor has said and the w/c carrier has denied coverage. The purpose of your letter is to put them on notice of the potential claim the employee has under the health insurance plan. The employee may still want to pursue a w/c claim and has every right to do so. As to who is responsible for the medical treatment, that is between the w/c carrier and the health insurance carrier. Let me know if we need to discuss further.

John Phillips
Editor, Tennessee Employment Law Letter
423/785-8325

Janet

Our operations are in IN, although we have a location in TN, so I'm vaguely familiar with TN w/c. Our w/c carrier always suggests that the company pay for the first visit, then if the injury is determined to be not w/c, the EE's insurance is responsible for any further treatment. According to our w/c carrier, this small price saves a lot of hassles and creates some degree of goodwill with the EE.