Disclaimer
This article does not provide legal advice. It is for informational purposes only.
Detailed Answer
Under Georgia law, workers’ compensation covers reasonable and necessary medical treatment for work-related injuries. To confirm whether payments were applied to your medical bills, follow these steps:
- Obtain Explanation of Benefits (EOB). Your insurer or claims administrator must send an EOB after each billing cycle. This document shows billed charges, payments made by the workers’ compensation carrier, and any patient responsibility. Review it for date of service, provider name, billed amount, paid amount, and adjustments.
- Request itemized bills from your provider. Ask your doctor or hospital for a detailed, itemized statement. Compare the billed amount with the insurer’s payment on the EOB. If you see a balance that should be covered, note the dates and procedure codes.
- Check insurer records under O.C.G.A. §34-9-81. Georgia Code §34-9-81(a) requires the employer or insurer to furnish medical benefits without delay. If payments are missing or delayed, submit a written request to the insurer to provide a full accounting of all payments made on your behalf. Refer to the statute at O.C.G.A. §34-9-81.
- Contact the Georgia State Board of Workers’ Compensation. If the insurer fails to respond or you dispute the account, file a request for assistance or a hearing. The Board can compel the insurer to produce records and explain any unpaid balance. Visit the Board’s website at sbwc.georgia.gov for forms and guidance.
- Keep detailed records. Maintain copies of all bills, EOBs, correspondence, and requests. Good record-keeping strengthens your position if you need to escalate the issue.
Helpful Hints
- Review each EOB as soon as you receive it to catch errors early.
- Match procedure codes on the itemized bill to those on the EOB.
- Ask for a ledger or statement of account from the claims adjuster if you need a full payment history.
- Use certified mail for written requests to create a clear timeline.
- Consult a qualified attorney if the insurer continues to deny or delay payment.