Fourth Quarter 2020
By: Austin Moore
In a compensable Illinois workers compensation claim, can a medical provider seek reimbursement from an employee?
No, in Illinois a medical provider cannot seek reimbursement from an employee under the Illinois Workers’ Compensation Act in a compensable workers’ compensation claim. However, there are procedures by which the medical providers can seek payment from the employer which will be explored in the next newsletter.
Under Section 8.2(e) of the Illinois Workers’ Compensation Act, medical providers cannot seek reimbursement from employees for procedures, treatment, or services rendered in connection with a compensable injury. For example, if the employer accepts compensability for its employee’s workplace accident, the employer is liable to pay for reasonable and necessary medical treatment per the Illinois Fee Schedule related to the compensable body part injured while in the course and scope of employment. The medical provider would not pursue reimbursement from the employee since the employer accepts liability and pays related medical bills for the employee’s procedures, treatment, or services. The provider cannot seek additional reimbursement beyond the payment under the Illinois Fee Schedule.
If a dispute arises during the course of medical treatment for which the employer wishes to dispute payment of further medical bills, then the employer can advise the medical provider of the dispute regarding the bills. The medical provider may not seek reimbursement from the employee during the life of the claim for amounts in dispute related to the workers’ compensation claim.
However, it should be noted that upon a final award or judgment by an Arbitrator or the Commission, the provider may notify the employee as to their responsibility for any procedure, treatment, or service that was rendered by that provider. If the provider seeks reimbursement from the employee following settlement, they shall not require a payment rate, excluding interest, greater than the lesser of the actual charge or payment level set by the Commission in the fee schedule. Generally, this is only applicable if the medical treatment was disputed and the employer prevailed at trial.
If you are handling a compensable claim and a medical provider reaches out to the employee to request reimbursement for medical treatment related to the compensable workers’ compensation claim, you can advise them that they should direct inquiries to you about payment. Furthermore, you can advise them only payment pursuant to the Illinois Fee Schedule will be issued. If there are any disputes regarding medical treatment payment, then you should notify the provider of the pending dispute.