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Doug Landau
Doug Landau
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Costs of Workers' Surgeries Vary by State

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Workers Compensation adjusters constantly bemoan the costs of medical care for injured workers in Virginia. The comp insurers also complain about utilization, since weekly wage benefits are capped, but the costs of medical treatment is not. Herndon Reston area workplace injury lawyer Doug Landau recently responded to a post about a Workers Compensation Research Institute ("WCRI") study that examined medical billing data from 17 states over a seven-year period. The WCRI study noted that common surgeries for workplace injuries generally cost less in states that have adopted per-procedure fee schedules, versus states that do not use fee schedules. The Workers Compensation Research Institute of Cambridge, Mass., examined medical cost data from 17 high-population states between 2003 and 2009, discussed utilization but was seemingly silent on the issue of how timely doctors and hospitals who treat injured workers are paid. Because of this silence, lawyer Landau wrote,


"As a lawyer who practices in several states along the East Coast, I wondered about the trends in medical care costs. What is missing from the study is the "Gorilla in the Corner" – the time value of money. Virginia may have a higher price tag for a given procedure, but the delay by the insurance companies and TPAs mean than many doctors that treat my clients do not get paid for many months or years. Plus, after the reduction for "usual and customary" and "peer review" the effective billing rate is sometimes pennies on the dollar."


In two cases tried by the Herndon law firm ABRAMS LANDAU where there was no question that the employee sustained a compensable on the job injury, the insurance companies have contested the doctors' and hospitals' bills totaling several hundreds of thousands of dollars. Despite winning both cases at the trial level, the insurance company lawyers have appealed to the Full Commission. In one case, a health care worker slipped & fell on the ice, reported back to work, suffered a brain injury that required her skull to be removed, and has now had a second stroke, and, in the other case, an airline pilot slipped and fell on the tarmac, injured his knee, and when he went in for a arthroscopic surgery, developed a clot that nearly killed him. In these cases, the doctors will not be paid their full billing, they will be paid so long after these surgeries and hospitalizations that their final payment will be pennies on the dollar, and in both cases, the injured worker will have paid enormous co-pays and deductibles while waiting for the decisions on appeal.