Greetings,

Often, the initial PFB filed in a claim seeks payment of hospital-related bills along with other claims.  And many times, we don’t have the records yet from that treatment to know if it was in fact related to our accident.

The traditional PFB response during the guideline-fee era had always been something to the effect of “the bills will be requested on proper form and will be paid at fee schedule if causally related.”

The key phrase in that sentence, “if causally related”, is technically not agreeing to provide the benefit.  That is a maybe I will, maybe I won’t, I’ll tell you later.  If you respond with a maybe and  then pay the bills more than 30 days after the PFB, there is a good chance a JCC will find that you owe a fee to the claimant’s attorney.

A possible suggestion to avoid this situation is to respond specifically, listing your injury or the accident.  Something like:

“The bills have been requested on proper form and the Employer/Carrier agrees to pay for all treatment related to the compensable  back injury of (date of accident)”

Or

“The bills have been requested on proper form and the Employer/Carrier agrees to pay for all treatment related to the compensable fall off the ladder”

The other key part of that response is that the bills “have been” requested rather than “will be”.  If you agree to provide a benefit in a PFB response but then do nothing to provide it, you may owe a fee.  I have seen cases where waiting two months after the response to provide the benefit created fee entitlement.  At the time of your response, take the extra step and request the bills on proper form, and diary yourself to follow up.  Otherwise, it is all for naught.

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Don’t forget about our afterhours Tampa CEU event, “So you can’t come to the convention…” mini-convention…flyer attached.   Friday, 7/21/17, hope to see you there.

Sincerely,
Morgan Indek | Partner