There have been recent changes in Wisconsin’s workers compensation law which may impact a patient with this type of claim. The chiropractor treating these types of patients should be aware of various legal implications of the law, including these five major factors:
- There are presently no recognized lien right privileges for the treating doctor. Under the current case law existing in this state, the lien rights of a doctor to receive compensation out of any settlement is only recognized in civil cases, such as personal injury litigation filed in circuit courts. Although it can be argued that the same principles should apply to worker’s compensation cases, no such case law presently exists. As such, it is still RECOMMENDED that the doctor have a signed lien (or assignment of benefits form) which is filed with the responsible insurer(s) and patient’s legal counsel. There are extensive articles and forms at this cite dealing with protection of the doctor’s lien rights.
- Treating Doctors do not have a right to appear or participate in a pending claim. Partially because of the lack of recognized lien rights, the doctor lacks the right to be named in the claim and receive notices relating to the disposition of the claim. Additionally, many attorneys will not share information on the case with the doctor because they regard it as confidential or privileged in nature. It is RECOMMENDED that the doctor consider adding specific language to intake forms or obtain “authorizations” permitting the patient’s legal counsel to share vital information about the case.
- Refunds of payments for treatment requested by Workers Compensation Insurers are generally not required. The patient’s insurer may eventually deny a claim even after it has begun payments to the patient’s chiropractor. In those situations, the insurer may request reimbursement from the doctor for previous payments under an assertion that there was some “mistake”. Except for certain types of SSDI payments, the doctor is generally not required to make any reimbursement to the insurer. So it is RECOMMENDED that a doctor receiving such a request ask for the “legal basis”of such a request and consider referring the matter to the Insurance Commissioner’s Office.
- The time period available to recover for unpaid treatment charges may be adversely affected by the pending worker’s compensation claim. The doctor should keep in mind that the time limit for filing a worker’s compensation claim exceeds the statute of limitations for filing a collection action. Many doctors will passively wait for the decision in workers compensation before pursuing recovery on the unpaid invoice only to learn that no recovery can then be obtained. As such, it is RECOMMENDED that the doctor (1) pursue collection proceedings in a timely manner, (2) have a written agreement with the patient to extend the statute of limitations on future litigation’ or (3) obtain a written letter of protection from the patient and/or the attorney that payment will be made at a later time.
- There may be multiple sources of recovery for the underlying accident. Although workers compensation may be the exclusive source of recovery for a “work place accident”, there are situations in which multiple parties and their insurers may be liable for a patient’s treatment charges. It is RECOMMENDED that doctors remember that charges for patient care may also be submitted to these other sources of insurance coverage; often including, disability policies and medical pay coverage under auto policies.
Finally, keep in mind that the state agency which oversees worker’s compensation claims can also address questions and provide useful information on issues involving worker’s compensation patients.
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