Court Reverses Decision: Employer Now Required to Pay Hospital Expenses for Injured Employee

Being injured at work can be frustrating, scary, and confusing. The law is clear, however – if you’re injured at work, you should be compensated for lost work time and medical care. However, the employer and the worker’s compensation carrier must follow the regulations set out by law to properly deny coverage for your claim.

Click below to review the court’s decision reversing the trial outcome. At the trial level, Benn Haro & Isaacs represented the injured employee. The appellate court reversed a decision made by the Judge of Compensation Claims, which denied the injured employee coverage for a hospital stay following an injury.

The appellate court decided that the employer should have formally denied the claim for hospitalization earlier if they were going to deny the claim under the Pay-and-Investigate statute. In other words, the employer was required to pay all benefits due “as if the claim had been accepted as compensable” until they denied the claim outright. Thus, the fact that the employer waited until after the hospital stay to deny the claim means the employer should pay the hospital claim (but not any subsequent costs incurred).

In addition, the appellate court sent the proceedings back to the lower court to investigate other defenses that the employer had that were not addressed by the lower court originally. The appellate court found that the employer was entitled to a 10-day approval period when the injured employee was referred to the hospital for specialist care and surgery. In other words, the employer and insurance carrier have 10 days to deny coverage of referral to a hospital (which the carrier did), and therefore not be liable for payment of the hospital bill, UNLESS the care provided was emergency care. The question remaining for the lower court to determine is – was the care provided constituted “emergency care.”

This appellate decision was a case that Benn, Haro, & Isaacs argued at the trial level. If you are interested in a complimentary consultation to discuss your case we would be pleased to meet with you. Recall, there are no fees or costs unless we win your case for you. 954-324-COMP (2667). [email protected]


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