Under Illinois workers’ compensation law, you are entitled to reasonable medical care related to your injury and 100% of it is to be paid for by the employer or their insurance company. Seems pretty straight forward, right? You get hurt at work, they pay for your care and if you don’t have health insurance it doesn’t matter.
Of course insurance companies aren’t known for doing things in a straight forward manner. The issue to them isn’t your health. The issue is how little can they pay and get away with it.
As an attorney it’s a constant game of cat and mouse as you really have to be on the lookout for the games they will play to reduce their costs and try to stick you with the bills.
The latest one I noticed was language inserted by an insurance company attorney in to a settlement contract recently.
Respondent accepts liability for medical bills that are reasonable, necessary, and related pursuant to the fee schedule or agreement, whichever is less, through the date of MMI of —– presented prior to settlement contract approval.
In plain English this means that if you can’t prove you gave them a bill before the settlement contract is approved and it comes up later, it’s your bill to pay.
If healthcare in this country was straight forward, this clause wouldn’t be a problem. But if you have had a surgery you know that you don’t just get a bill from the hospital, you get one from the doctor who does the surgery some times, the anesthesiologist sometimes as well as other providers and vendors. You might think you’ve paid all the bills, but you could then have one pop up out of the blue.
So what are you to do in this situation?
First, this is a bad contract if you have a lazy lawyer. To protect yourself I recommend that you personally call every medical provider BEFORE you sign a settlement contract and ask them for an itemized bill and physically prove that nothing is owed. If you had a surgery, call up the hospital or surgical center and ask if there is anyone else that could be sending a bill and get it in writing.
The other strategy is to refuse to sign off on this type of contract and instead ask the language in the contract to state that they will pay for related medical bills for treatment from before the contracts are approved.
This is all about protecting yourself.
Bonus tip, if you have medical bills that aren’t paid while you are still treating, that can hurt your care. Your attorney can file a trial motion to make them pay and for penalties and fees for their bad denial. Your health shouldn’t suffer because the insurance company is playing games.
Second bonus tip. It’s illegal for a health care provider to report you to a credit bureau for an unpaid bill or try to collect from you while you have an active case pending.
And as always, if you have any questions or concerns, call us for free. We cover all of IL.