65.2-714 - Fees of attorneys and physicians and hospital charges.
§ 65.2-714. Fees of attorneys and physicians and hospital charges.
A. Fees of attorneys and physicians and charges of hospitals for services,whether employed by employer, employee or insurance carrier under this title,shall be subject to the approval and award of the Commission. In addition tothe provisions of Chapter 13 (§ 65.2-1300 et seq.) of this title, theCommission shall have exclusive jurisdiction over all disputes concerningsuch fees or charges and may order the repayment of the amount of any feewhich has already been paid that it determines to be excessive; appeals fromany Commission determinations thereon shall be taken as provided in §65.2-706. No physician shall be entitled to collect fees from an employer orinsurance carrier until he has made the reports required by the Commission inconnection with the case.
B. If a contested claim is held to be compensable under this title and, aftera hearing on the claim on its merits or after abandonment of a defense by theemployer or insurance carrier, benefits for medical services are awarded andinure to the benefit of a third party insurance carrier or health careprovider, the Commission shall award to the employee's attorney a reasonablefee and other reasonable pro rata costs as are appropriate from the sum whichbenefits the third party insurance carrier or health care provider. Such feesshall be based on the amount paid by the employer or insurance carrier to thethird party insurance carrier or health care provider for medical, surgicaland hospital service rendered to the employee through the date on which thecontested claim is heard before the Deputy Commissioner. For the purpose ofthis subsection, a "contested claim" is an initial contested claim forbenefits and claims for medical, surgical and hospital services that aresubsequently contested and litigated or after abandonment of a defense by theemployer or insurance carrier.
C. Payment of any obligation pursuant to this section to any third partyinsurance carrier or health care provider shall discharge the obligation infull. The Commission shall not reduce the amount of medical bills owed to theCommonwealth or its agencies without the written consent of the Office of theAttorney General.
D. No physician, hospital, or other health care provider as defined in §8.01-581.1 shall balance bill an employee in connection with any medicaltreatment, services, appliances or supplies furnished to the employee inconnection with an injury for which an award of compensation is made pursuantto § 65.2-704. For the purpose of this subsection, a health care provider"balance bills" whenever (i) an employer or the employer's insurancecarrier declines to pay all of the health care provider's charge or fee and(ii) the health care provider seeks payment of the balance from the employee.
(Code 1950, § 65-98; 1968, c. 660, § 65.1-102; 1982, c. 439; 1985, c. 445;1987, c. 559; 1988, c. 544; 1991, c. 355; 1994, c. 707; 1995, cc. 214, 266.)