Can Collection Agencies Pursue Unpaid Workers Comp Medical Bills?
We received a phone call from an injured worker who was being pursued by one of the big collection agencies. The zombie medical bill was for excess charges over the fee schedule in a certain unnamed southwestern state.
If the state operated under a Usual and Customary system for Workers Comp, this situation might occur if the medical provider was not satisfied with the approved U&C amount. The carrier’s medical bill processor and the medical provider might not agree on what should be paid. The claims adjuster usually becomes involved in settling the U&C amount.
The injured worker had been injured on the job that required two major hand surgeries. The claimant was out of work for six months and had a gainful return to work. He was not represented by an attorney. The insurance carrier had paid everything including the medical bills timely. .
Three Instances Where The Collection Agency May Be Correct
I have seen three examples of how this situation may occur in a Workers Comp claim:
- Denied Claim – If the insurance carrier denied the claim, they will issue no medical payments on the file. Filing it with the health insurance carrier may possibly result in some type of medical payments to the provider.
- U&C – mentioned previously could have left some type of balance
- Treatment not related to the WC claim. Some of the medical treatment rendered may not have been related to the claim. This happens more than one might think. Medical bill processors catch these very often. Previously undiscovered high blood pressure and diabetes treatment and medication are two that occur often in files.
Collection Agencies and The Big No-No
If the claim was covered under workers comp, the collection agencies should not contact the injured worker especially on an old zombie medical bill.
Adding the zombie debt to someone’s credit report and contacting them by phone, email, etc. will not fly.
What To Do?
As I explained to the injured worker, send the communications to the workers comp carrier as soon as possible. Even though the Biden Administration has removed medical debt from credit reports, that does not mean that one can ignore the zombie bill.
Mail, scan and email, or fax the bill to the insurance carrier promptly. If the zombie debt collection agency keeps pursuing, then click here for a list of the State Attorney General Offices
The AG offices usually contain a section for unfair credit collection.
