Fourth Quarter 2020
By: Stephen P. Murray
In a compensable Nebraska workers compensation claim, can a medical provider seek reimbursement from an employee?
In Nebraska, medical providers are subject to the court’s fee schedule for compensable claims, however, there is no direct statutory law preventing a provider from seeking reimbursement from an employee. The process regarding how a medical provider seeks reimbursement from either an employee or employer will be discussed in the next newsletter.
In Nebraska, compensable workers compensation claims are subject to a fee schedule pursuant to Neb. Rev. Stat. 48-120(1)(b). As such, the court has essential carte blanche on medical treatment provided to an injured worker for treatment of an actual compensable work-related injury.
Pursuant to Neb. Rev. Stat. 48-120(3), [n]o claim for such medical treatment is valid and enforceable unless, within fourteen days following the first treatment, the physician giving such treatment furnishes the employer a report of such injury and treatment on a form prescribed by the compensation court. The compensation court may excuse the failure to furnish such report within fourteen days when it finds it to be in the interest of justice to do so. When a physician or other provider of medical services willfully fails to make any report required of him or her, the compensation court may order the forfeiture of his or her right to all or part of payment due for services rendered in connection with the particular case. Neb. Rev. Stat. 48-120(5).
The general rule is that the Nebraska Workers’ Compensation Court has the power to order an employer or its insurer to directly reimburse medical care providers if such care is deemed medically necessary and reasonable to treat a compensable injury. Kimminau v. Uribe Refuse Service, 270 Neb. 682 (2005).
Should an employee pay a medical bill sent to him or her from a provider, there is guiding case law on what the obligations of the insured is assuming the treatment was reasonable to treat a compensable injury. In VanKirk v. Central Community College, the Court ruled that upon receipt of payment from an employer, a supplier or provider of services becomes obligated to reimburse an employee any amounts he or she has previously paid. VanKirk v. Central Community College, 285 Neb. 231, 826 N.W.2d 277 (2013).
In practice, medical providers bill injured workers all the time. If this occurs, the most practical solution is for the adjuster to review the bill and put in line for payment if the treatment is reasonably necessary for treatment of a compensable injury. Medical providers should be made aware that such treatment is for treating a worker’s compensation as soon as practicable so ongoing billing can be sent through the fee schedule/directly to the carrier. If a medical provider fails to comply with Neb. Rev. Stat. 48-120(3), it is recommended to note this and discuss with the assigned defense attorney whether such bill should be denied based on the facts of the particular case.