Over the last decade, Florida’s Legislature responded to charges of skyrocketing worker’s compensation costs by enacting sweeping reform. One of the critical changes was to restrict claimant’s attorney’s fees to a schedule that at times amounted to $1.53 per hour. While this may have helped reduce worker’s compensation premiums for hospitals it also made collecting worker’s compensation claims increasingly difficult. Lawyers, it seems, don’t want to take on cases that pay $1.53 per hour.

 

Add to the sludgy mix that the law also prohibited attorneys from accepting worker’s compensation cases under any other terms than the draconian 15%-20% of the recovery set by the fee schedule (while insurers lawyer’s fees were unrestricted) and we quickly see why hospitals rarely had lawyers dashing off to battle worker’s compensation carriers over $1,250 emergency room visit denials or $2,300 scan charges. Financially, it just didn’t make sense. And the insurers knew it – which led to widespread denials and underpayments of hospital claims.

 

However, in the last few months Florida’s courts have stepped in with some critical decisions restoring the right to an attorney (and more specifically, a fairly compensated attorney) for those challenging improper claims handling by a worker’s compensation insurer. Court’s now say that an insurer who wrongly denies a worker’s compensation claim may be liable to pay a reasonable amount for the insured claimant’s attorney’s fees. In other words, a worker’s compensation insurer who wrongly denies a claim may be ordered to pay not just the claim for the hospital charges but also the fees of the attorney who prosecutes the case – a strong disincentive for insurer’s to play the attrition game.

 

So, how does this help hospitals? Isn’t this just for the injured worker? The answer in short is – “No!” Hospitals often accept an assignment of insurance benefits from the patient meaning that the hospital pursuing payment may step into the shoes of the patient and pursue its own claim against the insurer directly – going back as far as two years.

 

While old cases once restricted a health care provider from bringing a direct claim against an insurer, the Supreme Court of Florida has since afforded assignee health care providers a much broader right to pursue their own claims against insurers. I know my firm helped establish this right for medical providers seeking payment of P.I.P. and other insurance benefits. So now, hospitals confronting challenges to payment of their worker’s compensation claims have a powerful arrow in their quiver – an attorney who will take on the insurer for zero percent of the recovery (the insurer must pay the attorney’s fees in addition to the benefits owed to you).

 

So remember, when your worker’s compensation insurer takes you to task, know that you have the right NOT to remain silent. And you have the right to an attorney, finally!