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Getting Medical Bills Paid Under the LHWCA - Longshore Act

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“When I seek out professional advice, I don’t want B.S. I want it straight up, with no double talk. I figure do also. I always use plain English, with no sugarcoating no B.S lawyer talk, and no double talk- just old fashioned, unsweetened, unvarnished truth-just the way that I would want it.” -Bill Turley

The First Step

When it comes to Longshore Act Cases, nothing is more important than telling the truth. Nothing is more important than your credibility. You need to be up front and honest about every detail about your case.

Do not exaggerate the fine print. If a judge suspects your not being truthful, then they will dismiss your case. Always be honest. Always tell the truth.

Do your research on Longshore Act Cases and order my free book, Win Your Injury Case: The Ultimate No B.S. Guide To Avoiding Insurance Company Tricks That Ruin Your Case [even before you hire a lawyer]

 It is full of helpful and useful information when it comes to your Longshore Act Case.

 Need help right now?

 Give our office a call at (619) 234-2833. Our team of knowledgeable staff are here to help and listen.

How to get medical bills paid under the Longshore and Harbor Workers Compensation Act?

One of the questions that seem to have come up a lot over the years by both claimants and their doctors/ medical providers is what happens if the employer/ Longshore insurance company refuse to pay their medical bills?  So in this post, I thought I would provide some information in this regard.

Unfortunately, this is not an uncommon scenario.  Under the LHWCA - getting medical bills paid is not a simple answer.

First, you can negotiate directly with the employer/ insurance company. My guess is that you have tried this.  If not, this is your next step. Second, the claimant and/or the medical provider can litigate the medical bill claim.

 

Litigating Medical Bills

If you go the litigation route, either the claimant or the medical provider (that has an unpaid medical bill); needs to first request an informal conference with the United States Department of Labor.  You will need recommendations.  This is an important step.  In many locations having the informal recommendations in your favor will determine whether you later get your attorney fees paid by the employer/ insurance company.

Next claimant or the medical provider will need to file an LS-18 and request a Formal Hearing. Also known as a trial with the administrative law judge. Then you will have a trial (Formal Hearing).

You will need to prove that the claim falls under the  Longshore and Harbor Workers Compensation Act (LHWCA) or one of its extensions: Defense Base Act (DBA), Non-Appropriated Fund Instrumentalities Act (NAFIA). Outer Continental Shelf Lands Act (OCSLA).

Next you will need to demonstrate that there was a request for treating physician made with the employer/ insurance carrier. An exception to this rule would be emergency medical care.  Generally, there should also have been a request for authorization for such medical treatment from the employer/ insurance carrier.

You will need to prove that the medical treatment is reasonably necessary to cure the effects of the injury. And you will need to prove that the bills and/or rates charged are consistent with the Office of Workers Compensation Programs (OWCP) Medical Fee Schedule.

For prescription medication there is a OWCP formula that is used.

 

Practical Considerations

Unless the medical bills are significant, this is an expensive process for medical providers to undergo. However, if you are successful, you are entitled to reasonable attorney fees.  However, you or your attorney (if taken under a contingency fee arrangement); may not feel they are so “reasonable.”  In other words, the fees approved are generally on the low end.

Thus, you are probably going to be relying on the claimant’s lawyer to make sure you get your medical fees paid.  This is why it may behoove you to make sure the Longshore / DBA/ NAFIA/  OCSLA patients that you provide medical treatment for have seasoned counsel that understand the forgoing system.

Similarly, the same thing goes for claimants.  You want to make sure the your lawyer is a seasoned Longshore / DBA/ NAFIA/  OCSLA lawyer in order to make sure you get the medical treatment that you are entitled to.

 

 

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We handle Longshore/ DBA/ NFIA/ OCSLA cases from across the USA and around the world.

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