Detailed Answer
If you received treatment for a workplace injury, you have the right to confirm whether your workers’ compensation carrier paid your medical provider. Under Florida law, employers or their insurers must pay authorized medical bills according to the fee schedule in F.S. 440.13(2)(a) within 30 days of receipt, as required by F.S. 440.20. If a bill remains unpaid or unclear, follow these steps:
1. Obtain an Explanation of Benefits (EOB)
Your carrier or third-party administrator (TPA) issues an EOB after processing a claim. It shows what they paid, adjusted, or denied. Request copies of all EOBs related to your injury date from the insurer or TPA.
2. Request an Itemized Statement from Your Medical Provider
Contact the doctor’s office, hospital, or therapist and ask for an itemized bill. This statement lists each service, date, charge, payment by the insurer, and any remaining balance. Compare this against your EOB.
3. Review Your Billing Statements
Match each service date on the itemized statement with your EOB. If the insurer paid according to the fee schedule, you should see zero balance for covered treatments.
4. Contact the Insurer or TPA Directly
If you spot unpaid or unapproved bills, call the insurer or TPA. Provide claim numbers, dates of service, and provider names. Ask for an account ledger or payment history showing date and amount of each disbursement.
5. Document and Escalate If Necessary
Keep all correspondence in writing. If payments remain outstanding beyond the 30-day statutory window, you may request dispute resolution under F.S. 440.192. You also may file a Petition for Benefits with the Division of Administrative Hearings (DOAH).
6. Consult With a Qualified Attorney
If you cannot resolve billing issues, consider consulting a workers’ compensation attorney. They can guide you through hearings, mediation, or settlement negotiations.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for advice tailored to your situation.
Helpful Hints
- Always keep copies of medical bills, EOBs, and payment records.
- Note key dates: date of service, date insurer received bill, and date of payment.
- Request electronic access to your claim file to track payments in real time.
- Confirm whether your employer is self-insured or uses a third party; procedures vary.
- Act quickly—Florida’s deadlines for payment disputes can be short.