Insurance Company Ordered to Pay Full Amount of Landau Law Shop Client’s Medical Bills

challenge these unjust actions.  Some doctors become discouraged, go out of business and/or decline to treat those who are innocent victims of on the job accidents, injuries and diseases.  Herndon Trial Lawyer Doug Landau has several cases presently pending where the treating doctors are challenging the insurance companies’partial and delayed payments.  The team at Abrams Landau has worked with doctors and lawyers to remedy this unjust situation.  Landau and the staff at the Landau Law SHop have worked with former and present Deputy Commissioners, Judges and clients to combat these sharp Insurance industry practices.  Mr. Landau has appeared at Peer Review Hearings at Fairfax Hospital on behalf of doctors and their practices whose billings and/or treatment is called into question by the comp carriers.  Mr. Landau has been fighting against these dilatory tactics for over 20 years.

Insurance companies are now writing to doctors and telling them that their (the insurance company’s) nurses will determine compensability and they will decide how much to pay !  “Super Lawyer” Doug Landau has alerted the Virginia Workers Compensation Commission to this unhealthy practice, and the new pamphlet that is discussed in our prior posting is intended to curtail this sharp practice by the insurance companies.  Virginia law provides that:

“the fees of medical care providers for services rendered in connection with workers’ compensation claims shall be subject to the approval and award of the Commission.”

The Commission’s standard for how much the employer and its insurance company has to pay for medical services is, “SUCH CHARGES AS PREVAIL IN THE SAME COMMUNITY FOR SIMILAR TREATMENT…”

The state is divided into various communities against which this “prevailing Community Rate” standard is compared.  In other words, the charges of a doctor in Burke can be compared to the prevailing rates in Fairfax, Oakton, Herndon and Falls Church, but no Lebanon, Grundy or Danville.  The areas defined in Commission Rule 14 determine whether “the medical provider’s charges exceed the prevailing community rate” or not.

The Commission has rejected Insurance Company challenges where they relied upon their own internal, payer clients’ payments, or relied upon zip codes, or even CPT codes.  Where the Insurance companies have alleged that the doctors’ charges were “excessive”or that “multiple procedures were performed at the same time, the Workers Compensation Commission has held that these mere conclusory assertions were unpersuasive and insufficient to reduce the bills.  If your doctor is having trouble getting bills paid for the treatment of a workers compensation patient, call the Landau Law Shop at once.  Delay only works to the Insurance Company’s advantage.  Time is money, and only the health care providers lose if prompt action is not taken.  

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