                                 CODE OF VIRGINIA

FEES OF ATTORNEYS AND PHYSICIANS AND HOSPITAL CHARGES (§ 65.2-714)

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. The Commission
shall have exclusive jurisdiction over all disputes concerning such fees or
charges and may order the repayment of the amount of any fee which has already
been paid that it determines to be excessive; appeals from any Commission
determinations thereon shall be taken as provided in &#xA7; 65.2-706. The
Commission shall also retain jurisdiction for employees to pursue payment of
charges for medical services notwithstanding that bills or parts of bills for
health care services may have been paid by a source other than an employer,
workers&#8217; compensation carrier, guaranty fund, or uninsured
employer&#8217;s fund. No physician shall be entitled to collect fees from an
employer or insurance carrier until he has made the reports required by the
Commission in connection with the case.

B. If a contested claim is held to be compensable under this title and, after a
hearing on the claim on its merits or after abandonment of a defense by the
employer or insurance carrier, benefits for medical services are awarded and
inure to the benefit of a third-party insurance carrier or health care provider,
the Commission shall award to the employee&#8217;s attorney a reasonable fee and
other reasonable pro rata costs as are appropriate. However, the Commission
shall not award attorney fees under this subsection unless and until the
employee&#8217;s attorney has complied with Rule 6.2 of the Rules of the
Commission. The fee shall be paid from the sum that benefits the third-party
insurance carrier or health care provider. In determining whether the
employee&#8217;s attorney&#8217;s work with regard to the contested claim
resulted in an award of benefits that inure to the benefit of a third-party
insurance carrier or health care provider, and in determining the reasonableness
of the amount of any fee awarded to an attorney under this subsection, the
Commission shall consider only the amount paid by the employer or insurance
carrier to the third-party insurance carrier or health care provider for
medical, surgical, and hospital service rendered to the employee through (i) the
date on which the contested claim is heard before the Deputy Commissioner, is
settled, or is resolved by order of the Commission or (ii) the date the employer
or insurance carrier provides written notice of its abandonment of its defense
to the contested claim and shall not consider additional amounts previously paid
to a health care provider or reimbursed to a third-party insurance carrier. For
the purpose of this subsection, a &#8220;contested claim&#8221; is an initial
contested claim for benefits and claims for medical, surgical, and hospital
services that are subsequently contested and litigated or after abandonment of a
defense by the employer or insurance carrier.

C. Payment of any obligation pursuant to this section to any third-party
insurance carrier or health care provider shall discharge the obligation in
full. The Commission shall not reduce the amount of medical bills owed to the
Commonwealth or its agencies without the written consent of the Office of the
Attorney General.

D. No physician, hospital, or other health care provider as defined in &#xA7;
8.01-581.1 shall balance bill an employee in connection with any medical
treatment, services, appliances, or supplies furnished to the employee in
connection with an injury for which (i) a claim has been filed with the
Commission pursuant to &#xA7; 65.2-601, (ii) payment has been made to the health
care provider pursuant to &#xA7; 65.2-605.1, or (iii) an award of compensation
is made pursuant to &#xA7; 65.2-704. For the purpose of this subsection, a
health care provider &#8220;balance bills&#8221; whenever (a) an employer or the
employer&#8217;s insurance carrier declines to pay all of the health care
provider&#8217;s charge or fee and (b) the health care provider seeks payment of
the balance from the employee. Nothing in this section shall prohibit a health
care provider from using the practices permitted in &#xA7; 65.2-601.1.

HISTORY: 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;
2012, c. 543; 2014, c. 670; 2016, cc. 279, 290.