Considering the outcome of Emma Murray, I thought today I would highlight a case about attorney fees and payment of medical bills.  For many adjusters, the laborious process of paying doctor hospital bills is one filled with delays and red tape, particularly with getting the vendors to submit their bills properly (on HCFA forms).  More often than not, a vendor bill is paid weeks or months (sometimes years) after the date of service. 

Many Claimant attorneys took advantage of this and filed various petitions for benefits seeking payment of the delinquint bills, whenever Claimant’s recieved notices in the mail.  Many doctors and hospitals still send bills to injured workers even though payment is not their responsiblity (as dictated in section 440.13).   If a Carrier pays these bills more than 30 days after the filing of the petition, the Claimant attorney puts his hand out expecting a fee. 

That is until now, thanks to Orange County v. Willis.

In this First DCA case, Claimant treated with her doctor for many years.  During that time, the Carrier was purchased by another company and payment of the doctor’s bills slipped through the cracks to the tune of $20,000.  The opinion writes of the situation as a “mix up,” with no intent by the Carrier to skip out on the bills or deny Claimant with medical care.  In fact, the doctor continued to treat Claimant, seamlessly, throughout this period of time.

Section 440.13(11)(c)dictates that the Agency for Health Care Administration (“AHCA”) has “exclusive jurisdiction” to decide any matters regarding provider reimbursement.  As long as the Carrier authorizes care with the doctor, the dispute about the doctor’s bills is outside the jurisdiction of the Judges of Compensation Claims. 

In other words, the Claimant does not have a dog in this fight.  Only AHCA and the doctor does.

Fortunately, the First DCA recognized this in the Willis case and reversed the lower court’s decision to award Claimant’s attorney fees for payment of these delinquent bills.  The Court appropriately rationalized that “Claimant does not have standing to enforce payment of the doctor’s bill.”  Therefore, the payment of the bills are not a “benefit secured” as defined by section 440.34(3). 

As the petitions and fee demands begin to pile up it is important for Carriers to know about this case and respond appropriately if such an issue comes up.

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