Today's guest post was authored by Jon Rehm, Esquire of the Nebraska Bar.
Lawyers on “both sides of the v.” in Nebraska like to grumble about rules and regulations imposed by the workers' compensation court.
But ideally, rules make the workers' compensation claims process easier. A good example of the benefit of some bureaucracy in workers' compensation would be thefee schedule for medical bills required by statute and developed by the court on an annual basis. In simple terms, the fee schedule determines what an employer/insurer is required to pay for medical services in a workers' compensation claim. The fee schedule eliminates disputes over what constitutes a fair and reasonable charges in a Nebraska workers compensation case and in many other states.
One leading New Jersey workers' compensation defense firm predicted, almost gleefully, that soon 1/3rd of workers' compensation cases in the Garden State will involve cases between medical providers and insurers/claims administrators over medical charge. I hate to sound cynical, but as work injuries continue to decline, workers' compensation defense lawyers can grind billable hours in what amount to commercial disputes between doctors and insurance companies .
Putting aside jibes at the defense bar, a lack of a fee schedule means more time and expense proving up what is a fair and reasonable charge versus spending that time and expense on proving compensability and nature and extent of disability. Plaintiffs who aren't being paid benefits or receiving medical care have to wait for a court date while doctors and insurers spend court time arguing whether an insurer has to pay $.73 on the dollar for a procedure or $.87 on the dollar for a procedure. (By the way the decision in that case was 21 pages single space in a small font.)
Uncertainty over reimbursement for workers' compensation services would also discourage medical providers for treating workers' compensation patients. In my experience a mutually agreed upon fee schedule for medical charges for workers' compensation claims greatly simplifies workers' compensation cases. An administrative solution on medical costs in workers' compensation is much better than litigating the issue on a case by case basis.
Editorial note: An effort to establish mandatory arbitration in medical fee disputes was a subject of a failed NJ legislative effort. More recently, an effort was made to urge changes in the NJ Workers' Conpensation system to resolve medical fee claims in an efficient fashion. National commentators have urged that NJ finally establish a medical fee schedule in workers; compensation matters. Todate the issue remains unresolved the medical fee disputed continue to increase exponentially increasing disruption of the benefit system for injured workers.
**Jon Rehm has practiced workers compensation, employment law and personal injury law since 2005. He has represented employees in state and federal cases, in the Nebraska Workers Compensation Court, administrative proceedings in front of the Nebraska Department of Labor and Nebraska Equal Opportunity Commission and have also represented union members in arbitrations. Jon has presented about workers compensation and employment law for groups such as American Bar Association, the American Association of Justice, the Nebraska State Bar Association and the Nebraska Association of Trial Attorneys and at the University of Nebraska College of Law as well as to labor unions and management groups
ABOUT THE AUTHOR
Jon L. Gelman is nationally recognized as an author, lecturer and skilled trial attorney in the field of workers' compensation law and occupational/environmental disease litigation. Over a career spanning more than four decades, he has been involved in complex litigation involving thousands of clients challenging the mega-industries of asbestos, tobacco, lead paint and burn pits. He is the author of the 3-volume treatise entitled Workers' Compensation Law (West-Thomson-Reuters) and co-author of the national treatise of Modern Workers' Compensation Law (West-Thomson-Reuters).
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