If your workers’ compensation case has been admitted—meaning the insurance company has accepted responsibility for your injury—you might be surprised to still receive medical bills. You may even be frustrated or worried about collections. The truth is, this happens more often than you think, and it’s usually due to billing mistakes, delays, or miscommunication between providers and the workers’ compensation insurer.
Let’s break down why this happens and what you can do to stop it.
1. The Provider Doesn’t Realize It’s a Workers’ Compensation Case
One of the most common reasons injured workers receive medical bills is that the healthcare provider is unaware that the treatment is covered under workers’ compensation. Sometimes, the doctor’s office mistakenly bills your personal health insurance or sends the bill directly to you instead of the workers’ comp insurance.
What You Can Do:
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- Call the medical provider and inform them that your injury is covered under an admitted workers’ compensation claim.
- Provide them with the insurance adjuster’s contact information and claim number.
- Ask them to rebill the workers’ compensation insurance instead of sending you invoices.
2. The Workers’ Compensation Insurance Hasn’t Paid Yet
Even if your claim is accepted, insurance companies often delay payments or dispute charges related to medical treatment. If the provider doesn’t receive payment within a certain timeframe, they might bill you directly.
Under N.C.G.S. § 97-88.3 (in NC) and S.C. Code Ann. § 42-9-360(B) (in SC), medical providers are prohibited from collecting payments from injured workers for treatment covered under an accepted workers’ compensation claim. If a provider wrongfully bills you, they are in violation of the law.
What You Can Do:
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- Contact your attorney (if you have one) to push the insurance company to pay.
- Follow up with the insurance adjuster to confirm whether they received the bill and when they intend to process it.
- If necessary, reference N.C.G.S. § 97-88.3 (in NC) or S.C. Code Ann. § 42-9-360(B) (in SC) when disputing the bill, as these statutes protect injured workers from being personally billed for covered treatment.
- Request a detailed explanation if the insurance denies any part of the bill.
3. The Medical Provider Incorrectly Billed the Wrong Entity
Workers’ compensation has a different billing system than regular health insurance. If the provider doesn’t bill correctly, the claim could be rejected—leading them to bill you instead.
What You Can Do:
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- Ask for a copy of the bill and verify whether it was sent to the correct insurance carrier.
- Ensure the provider includes the proper workers’ compensation billing codes when resubmitting the bill.
4. The Insurance Company Is Disputing the Treatment
Even in an admitted case, the insurance company might challenge certain treatments, claiming they are not necessary or not related to your workplace injury. When this happens, the medical provider might turn to you for payment.
What You Can Do:
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- Speak with your attorney immediately. They can file a motion with the NC Industrial Commission or SC Workers’ Compensation Commission to force payment if the treatment is medically necessary.
- Do not pay the bill unless your attorney advises otherwise—if you pay, it might be harder to get reimbursed.
5. The Bill Wrongfully Went to Collections
If a bill goes unpaid for too long, the provider might send it to collections, even though you are not responsible for it under an admitted workers’ compensation case.
What You Can Do:
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- Have your attorney send a cease-and-desist letter to the collection agency, explaining that the bill is not your responsibility.
- Dispute the charge with the credit bureaus if it appears on your credit report.
- Request the provider pull the bill back from collections and bill the correct payer.
Final Thoughts: You Should Not Be Paying These Medical Bills
If your workers’ compensation claim has been admitted, you should not be personally responsible for any related medical bills. However, due to administrative errors, billing mistakes, and insurance delays, providers sometimes wrongfully bill injured workers.
The good news is that the law prohibits providers from attempting to collect payment from injured workers for covered treatment. An experienced workers’ compensation attorney can stop these billing issues, force the insurance company to pay, and protect you from collections.
If you’re dealing with medical bills in your admitted workers’ comp case, don’t ignore them—take action today to ensure your rights are protected.