You got hurt at work, you did what the company told you to do, and now a bill from the clinic is sitting on your counter with your name on it. Or the check that has been covering your rent did not come this week. Nobody called to explain either one.
So who is supposed to pay this bill? Is the insurance company allowed to just stop sending your checks? And how long are you supposed to wait before something is actually wrong?
I am Mark Hirsch. I handle Florida workers' compensation claims, plus Longshore Act claims for dock and shipyard workers around the country. When workers' comp is not paying medical bills or weekly checks, there is usually a deadline in Florida law that has already run out, and almost nobody gets told about it.
Here is the short answer. When workers' comp is not paying your medical bills, you are still not the person who owes that money. Florida law puts the bill on the insurance company, and it gives that company a deadline.
- The insurance company gets 45 days from the day it receives a medical bill to pay it, reduce it, or deny it in writing.
- You are not liable for the cost of authorized treatment for your work injury.
- When one of your weekly checks runs more than 7 days late, Florida adds 20 percent to that check, plus 12 percent a year in interest.
- Florida runs a free helpline for injured workers at 1-800-342-1741, and looking into stopped or suspended benefits is part of what that office does.
How I know: the medical rules are in Florida Statute 440.13, and the payment deadlines and the penalties are in Florida Statute 440.20.
By the end you will know whether you owe that bill, why the insurance company has not paid it yet, how long your first check is allowed to take, what Florida adds when a check is late, and the five things to do the week the money stops.
Key Takeaways
- Your first check, or a written denial, is due by the 14th day after your employer hears you were hurt.
- An insurance company that pays you for 120 days and never denies the claim gives up the right to call your injury non-work-related later.
- Tell the insurance company within 5 business days of going back to work, because not telling them is itself a reason your checks can be suspended.
- Filing a Petition for Benefits gives the insurance company 14 days to pay what you asked for or answer you in writing.
Do I have to pay this workers' comp medical bill?
No, not for treatment the insurance company authorized for your work injury. Florida law says it plainly: you are not liable for the cost of that care. Here is how the money is supposed to move.
You see the authorized doctor. The doctor's office sends its bill to the insurance company handling your claim, not to you. The insurance company pays the office directly. You never touch the money, and on a claim that runs properly you never see a statement at all.
So a statement with your name and a balance on it means something went wrong between that office and the insurance company. It is not something you did, and paying it is not the fix. Call the office, give them your claim number and your adjuster's name, and ask them to bill workers' compensation instead. Then keep the statement.
One kind of bill really can end up yours: care nobody authorized. If you picked a doctor on your own and the insurance company never approved that visit, the protection above may not cover it. That is worth a phone call before the appointment, not after.
Why workers' comp is not paying your medical bills yet
Most unpaid bills come down to one of five things, and only one of them is a real denial. Before you argue with anybody, work out which one you are looking at.
One deadline does most of the work here. The insurance company has 45 calendar days from the day a bill reaches it to pay that bill, reduce it, or deny it.
Two shorter deadlines cover the rest. When your doctor's office asks permission to treat you, the insurance company has to answer by the close of the third business day after the request. Your doctor's office also owes the insurance company a first notice that it treated you, by the end of the third business day after your first visit.
| What went wrong | Whose job it is to fix it | What you do this week |
|---|---|---|
| The bill is less than 45 days old | Nobody yet. The insurance company still has time | Ask the office for the date it sent the bill, and write that date down |
| Nobody ever authorized the treatment | The doctor's office has to ask for authorization | Ask the office for a copy of its request and the date it went out |
| The office billed your health plan by mistake | The doctor's office | Call and give them the claim number and the adjuster's name |
| The office never sent that first notice of treatment | The doctor's office | Ask the office whether it sent the notice, and when |
| The insurance company turned the whole claim down | The insurance company, in writing | Read the denial letter for the reason it gave, then see below |
That last row is a different fight from the other four. If your claim was denied outright, the unpaid bill is only the part you can see, and the denial is what you have to answer.
How long does workers' comp take to pay you, and what if the check is late?
Your first check is due by the 14th calendar day after your employer is told you were hurt. By that same day the insurance company has to either pay you or deny the claim in writing.
Paying or denying are the only two choices Florida gives the insurance company, so silence on day 20 is not a delay, it is a missed deadline.
After that, each payment has its own due date, and each one is measured separately. Here is the part worth knowing before you call the adjuster.
Once a payment is more than 7 days late, Florida adds 20 percent of that payment on top of it. Interest runs too, at 12 percent a year, counted from the day the payment was due until the day it actually arrives.
Why did my workers' comp check stop, and is that allowed with no letter?
People put this to me in one sentence: they stopped paying me without notice, and nobody will say why. Here is what Florida law says about that.
No. The moment the insurance company stops or suspends your payments, for any reason at all, it has to notify three parties right away: you, your employer, and the state. An insurance company that stopped paying you without notice has already broken that rule, whatever its reason for stopping was. Say exactly that in your first email to the adjuster.
Then find one date. It matters more than anything the adjuster tells you on the phone: the date of your very first payment.
Here is why that date matters. When an insurance company is not sure your injury is covered, Florida lets it start paying you anyway and decide later.
It gets 120 days from that first payment to accept the claim or deny it. Let those 120 days pass with no denial, and it gives up the right to deny your claim at all. The one way out is facts the insurance company could not have found by investigating properly during those four months.
So if the checks ran for months and then stopped because somebody decided your injury was not work-related, count the days. The adjuster may have already lost that argument.
Two ordinary explanations are worth ruling out first. If you went back to work and did not tell the insurance company within 5 business days, that alone is a reason your partial checks can be suspended.
And if your doctor recently said you are at maximum medical improvement, your check changes on its own, which I walk through in what happens after MMI.
If a smaller check has already started, the Florida workers' comp settlement chart shows how many weeks of it you are owed.
5 things to do the week the money stops
These five are what I ask about on a first phone call, and you can do all of them yourself before you ever hire anybody.
- Email the adjuster the same week, and keep the email. Name the payment and the date it was due, or name the unpaid bill, and ask for the reason in writing. A dated email is proof; a phone call two months ago is not.
- Call the state helpline at 1-800-342-1741. That is Florida's Bureau of Employee Assistance and Ombudsman. It is free, it looks into benefits that were denied, stopped or suspended, and an ombudsman there can help you write a petition.
- Write down the date of your first payment. It is the most useful date in your file, and it is the first thing I ask for on a call.
- Ask the doctor's office for a printed list of every bill it sent, and the date it sent each one. The send dates are what you need, and the billing office will have them on file even on a week when the adjuster will not call you back.
- Check your own deadline, and know that it moves. You have 2 years from the day you knew the injury came from your job, and every payment or treatment pushes it out to 1 year from that payment. Write down the date of your last check and keep it somewhere you can find it.
When emails stop working, the next step is a Petition for Benefits, which is how a Florida judge of compensation claims gets involved. You have to show you made a real effort to sort it out first, so the dated emails you already sent are the proof of that.
Once the petition is served, the insurance company has 14 days to pay what you asked for or file a written response, under Florida Statute 440.192.
Frequently Asked Questions
Q: The bill went to a collection agency. Am I still not the one who owes it?
A: The law does not change because a collector bought the debt. Write to the collection agency, tell them the treatment was for a workers' compensation injury, and give them the claim number, the insurance company and the adjuster.
Send the same letter to the adjuster, and keep copies of both. Do that early, while there are only a couple of letters to keep track of.
Q: Does that 20 percent penalty apply to my unpaid medical bills too?
A: No, and it is worth knowing before you count on it. That penalty only applies to your own compensation payments.
Late medical bills work a different way: the state measures how often each insurance company pays its bills on time, and fines it $25 or $50 a bill once it falls under the standard. Those fines go to the state, not to you.
Q: What happens if workers' comp doesn't pay even after I put it in writing?
A: Then a judge of compensation claims decides it instead of an adjuster, and your dated emails are what get you there.
One thing to check first: whether your employer carried coverage at all. An employer that never secured it loses three of its usual defenses in court under Florida Statute 440.06, and that gives you a court claim you would not otherwise have.
Checks Stopped or Bills Piling Up? Let Us Read the File.
Most of the deadlines above are already running, and nobody sends you a reminder when one passes. Our team at Templer & Hirsch, Injury Lawyers handles Florida workers' compensation claims plus federal Longshore and Defense Base Act claims, with no fee unless we recover. Call 305-937-2700 or request a free case evaluation.
This is general information, not legal advice; consult an attorney about your situation.