We are dealing with a bill from a client for an air ambulance company that provided services for an injured worker. Our client paid the air ambulance folks the amounts provided under the IL WC Medical Fee Schedule—the air ambulance folks accepted the payment. The air ambulance company is now claiming they don’t have to accept state regulation of their services, as they are federal in scope—in short, they want a lot more moolah.
We feel this is an interesting legal question. We are asking for your thoughts and input. There is no question an emergency air ambulance provider is providing a medical service for workers due to a work-related medical problem. We agree employers getting the benefits of such services for their workers owe for such WC benefits under state law. However, the air ambulance folks are claiming state law doesn’t apply to regulate them or their prices, under U.S. law.
The problem with that approach is they aren’t ferrying injured workers around for fun. The air ambulance folks know they are providing state-based workers’ comp services. It is our reasoned opinion an employer, insurance carrier or TPA owes them whatever the medical fee schedule provides or you don’t owe them anything because employers only owe your injured workers what is due under state law. This follows what we call the “Coca-Cola® Machine” model of workers’ compensation claims administration; you can’t get a coffee from a Coke® machine. Similarly, the Illinois WC Commission or the Indiana WC Board can only dispense one product; they can award state WC benefits and can’t do anything else.
In fact, we don’t feel an injured worker’s attorney can ask the IWCC to award unlimited benefits or benefits due under federal laws or the laws of another state/country. We feel they are limited to awarding Illinois state benefits only.
The air ambulance folks might sue your worker in quantum meruit for the reasonable value of their services—you don’t owe the employee a defense to such a claim because that duty isn’t outlined in the IL WC Act. You only owe your workers for statutory state WC benefits.
We have done online research. We feel this is the best and most current statement of the law on the topic: http://www.insurancelitigationregulatorylaw.com/tags/workers-compensation-1/
Please let us know your thoughts on this interesting topic.