It is the “mundane” details that seem to most often drive injured workers crazy when they have an Oregon Workers’ Compensation Claim. One of the great worries is whether the medical bills will be paid.
When the worker is getting treatment for an “accepted condition” from an Oregon medical provider there are provisions in the Oregon statutes that limit the amounts a medical provider can charge. Once the Workers’ Compensation Insurer pays the statutory allowed amount, the medical provider must accept that payment as payment in full. This protects injured workers from being responsible for medical bills connected with their workers’ compensation injury.
The problem some injured workers run into is when they get treatment for an Oregon Workers’ Compensation injury from an out of state medical provider. Because the Oregon laws do not apply to a medical provider who is not in the state of Oregon, the medical provider can charge any amount they choose. The Oregon Workers’ Compensation Insurer only has to pay the amount set by Oregon law. Often the amount set by Oregon law is less than the amount medical providers “normally” charge. This can leave the injured worker in the position of having to pay the difference between the amount paid by the Oregon Workers’ Compensation Insurer and the amount charged by the medical provider.
Most medical providers when treating an injured worker will accept the amount paid by the Workers’ Compensation Insurer as payment in full. However, an injured worker with an Oregon Workers’ Compensation claim who is getting treatment from an out of state medical provider has to be aware of the possibility they will be responsible for the difference between the amount paid by the insurer and the amount charged by the medical provider. Mentioning this issue to the out of state medical provider before starting treatment can prevent the injured worker from getting the unpleasant surprise of personally owing amounts for their medical treatment.
If you have been hurt in a motor vehicle accident in Oregon and need medical treatment, you are going to become familiar with an entirely new set of phrases and rules regarding payment of your accident-related medical bills.
Under Oregon law, a person who is injured in a motor vehicle accident is covered by the Personal Injury Protection (PIP) coverage of the insurance policy of the vehicle they were driving or riding in. The PIP coverage pays the injured person’s medical bills for treatment of the injuries suffered in the motor vehicle accident for up to one year after the accident and up to $15,000 of bills. These are the “minimum limits” of PIP coverage allowed in Oregon. Of course it is possible to buy additional PIP coverage, but the vast majority of drivers have the minimum coverage. In order to be paid under PIP coverage, the medical treatment has to be “reasonable, necessary and related to” the injuries suffered in the motor vehicle accident. Whether the automobile insurer determines treatment is “reasonable, necessary and related to” the injuries suffered in the motor vehicle accident and the process surrounding that determination will be covered in a future post.
Under Oregon law, a medical provider who accepts PIP payments is allowed to charge only that amounts which are authorized for those services under the rules governing workers’ compensation claims. Those allowed amounts are generally less than what the medical provider charges to most patients. However, once the medical provider accepts the PIP payment, the medical provider must accept that amount as payment in full and can not bill the patient for any difference between the “workers compensation amount” paid by PIP and the “normal charges.” Sometimes a client injured in a motor vehicle accident will be concerned because their doctor or medical provider has been paid by PIP, but the client has received a statement showing a balance owing for the difference between the amount paid by PIP and the “normal charges.” The client is then concerned about paying this additional amount because they think it is owed. Under Oregon law the medical provider has been paid in full and can not “Balance Bill” that is bill their patient for the difference between the amount paid by PIP and the “normal charges.” Most of the time, the client receiving a “Balance Bill” from their doctor is merely the result of a mistake in the billing department.