Workers’ Compensation Fee Schedules – Legal Issues that Affect Healthcare Providers and Third Party Administrators

Worker's Compensation Claim form for Comp on Injury employment

Pursuant to Federal and state laws, all employees covered by workers compensation may be entitled to medical care, payment for lost wages, and other applicable benefits – if they become ill or injured on the job. However, there are instances when workers compensation claims become the subject of disputes between employee and employer, employer and insurer, or employee and insurer.

One of the most common causes of workers’ compensation disputes arises from a conflict in the interpretation and application of workers’ compensation fee schedules.

While disputes are typically settled through mediation, there are instances when they become legal issues simply because one of the parties is not satisfied or does not agree with the conditions.

Some of the most common causes of disputes include:

  • Undervaluation of Claim
  • Improper Investigation
  • Human Error
  • Bad Faith

Any of these issues can arise, but as an employer, you can lower your risk by hiring a medical scheduling provider to manage your workers’ compensation benefits. As a workers compensation TPA we work to ensure effective medical management of injured employees and the prompt processing of their workers’ compensation claims.

If your workers’ compensation claim is denied or if you think it is undervalued, you have a chance to get it rectified by disputing your case with the insurer or in court. You may hire a workers’ compensation attorney to maximize your chances of turning the outcome to your favor.

There are lots of reasons why workers’ compensation claim disputes or legal issues arise. These typically affects an insurer or third party provider if they believe, claim or insist that:

  • The injury or illness of the claimant-worker did not happen on the job
  • The illness was a pre-existing condition
  • The claim wasn’t filed during the prescribed period
  • The employee failed to submit to a physical examination within the prescribed period
  • The evidence is insufficient
  • There’s a possibility of fraud

As an employer, it is your responsibility to provide your workers with a safe workplace and a workers’ compensation carrier or workers compensation TPA that submits an accurate and timely report of injury when an accident happens.

Call us at (866) 214-5920 for seamless workers’ compensation claims and medical management for your employees!