Greetings,
We have 30 days from the date a Petition for Benefits is electronically filed/served to respond to avoid owing attorney fees to the claimant’s attorney. Here are a few common missteps I have seen that can still expose us to fees or problems.
- Vague response to a claim for payment of a medical bill- Many times when a medical bill is attached to a PFB, we do not know what the treatment was for, or if it was related to our accident. If we say we will pay upon receipt if related, that is NOT agreeing to provide the benefit timely and caselaw says we still owe a fee. I recommend being “specifically vague”, and instead stating:
The E/C agrees to pay for treatment for the (insert compensable body parts) on the medical bill from (insert provider/date) when received on proper form and per FL fee schedule.
This way you are only agreeing to pay what is yours, if any of it, from the bill.
- Not agreeing to or not paying Penalties and Interest- If we are late in paying indemnity, no matter the reason, we owe interest (12% annual but a minimum of $5 per late check), and in most cases we will owe a 20% penalty as well. If the PFB asks for indemnity and we agree to pay it, but do not agree to pay P and I specifically or we don’t include it in the back payment, we could still owe fees even if the PFB is timely responded to by the adjuster. Always check for P and I exposure.
- Not amending the AWW for cancellation of the claimant’s Health Insurance- Almost all PFB’s that seek indemnity state “at the correct AWW”. Even if you know the AWW is correct based on a good 13-week wage statement and you are currently paying the claimant, it is a good time to check and make sure the HI has not ended. Regardless of why the HI stopped, we do need to increase the AWW from the date it ended by adding the ER’s cost oi the HI at the time of the accident. Make sure to go back and get the amount at the time of the accident because it can go up quite a bit each year.
- Responding too soon within 14 days- The WC statute contains conflicting information on responding to PFB’s. Under 440.192(8), it says a carrier must respond within 14 days of the PFB, BUT under 440.34(3)(d), no attorney fees attach until 30 days after the PFB is received. Many carriers require the adjusters to respond within 14 days which is a good practice, but there are sometimes we do not have the answers within the 14 days. If we are awaiting a medical report or AWW confirmation, etc…it may make sense to wait and respond correctly before 30 days, rather than deny or give an incomplete or incorrect response.
Keep in mind you CAN amend your response before 30 days expires and provide the benefits to avoid fees per caselaw.
- 1-time change request on a PFB- Even though you have 30 days to respond to a PFB to avoid fees, that does not apply to 1-time change requests. We still only have 5 days to respond. You don’t need to respond via PFB response, an email to the claimant’s attorney within 5 calendar days with the name of the new doctor will suffice. If you respond within 30 you don’t owe a fee, but the claimant will get to select the 1-time change doctor.
As always, please let me know if you have any questions!
Be sure to check the Events page of our website for upcoming FL/GA/TN webinars: https://eraclides.com/events/
Sincerely,
Morgan Indek | Managing Partner