How to Confirm Workers’ Compensation Payments on Your Medical Bills
Detailed Answer
When your employer’s workers’ compensation carrier pays medical providers, you’ll see those payments reflected on billing statements and Explanation of Benefits (EOB) forms. To confirm payment application, follow these steps:
1. Request an Itemized Statement or EOB
California Labor Code §4600 requires employers to furnish all “reasonable medical treatment . . . incurred as a result of the injury.” Medical providers send bills to the claims administrator, which issues an EOB detailing services rendered, payments made, and any outstanding balance. Ask your provider or the claims administrator for the EOB (often on form DWC‐EOB). Review it to verify which procedures are paid.
2. Check for Lien Filings
If a provider believes the insurer hasn’t paid, they may file a lien under Labor Code §4903.5. You can search lien records on the Division of Workers’ Compensation (DWC) website or request copies from the clerk’s office in your county. A lien release means the insurer satisfied the bill.
3. Contact the Claims Administrator
Call the insurer’s claims representative. Provide your claim number and provider name. Ask for a payment history report. Under California Code of Regulations, Title 8, §9792.21, the carrier must promptly respond to written requests about medical payments.
4. Compare Provider Statements
Obtain billing statements directly from your medical provider. After you receive the insurer’s EOB, match each service date and charge to the amounts the insurer reports. The difference, if any, shows any unpaid balance you might owe.
5. Seek a DWC Conference or QME Review
If you still dispute payment application, you can request an informal conference through DWC (Labor Code §5800) or ask for a qualified medical evaluator (QME) determination on billing issues. Visit DWC forms for details.
Helpful Hints
- Keep all correspondence and bills organized by date.
- Note the claim number on every request for quicker responses.
- Use certified mail or email with read receipts when requesting records.
- Review your employer’s workers’ compensation policy summary.
- If you hire an attorney, they can obtain records and negotiate directly.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for advice on your specific situation.