Disclaimer: This article provides general information and does not constitute legal advice.
Detailed Answer
Under Ohio law, employers and their insurers must pay all reasonable and necessary medical costs related to a workplace injury. The Ohio Revised Code requires payment of these bills directly to medical providers. Follow these steps to confirm that workers’ compensation payments were applied correctly:
- Obtain an Explanation of Benefits (EOB): Contact the Ohio Bureau of Workers’ Compensation (BWC) or your employer’s claims administrator. Request EOBs that show billed amounts versus paid amounts. You can access payment records through the BWC’s online portal or by calling (800) 644-6292.
- Review Provider Statements: Ask each medical provider for detailed billing statements and proof of payment. Compare total charges to amounts marked as paid by workers’ comp. If you see outstanding balances labeled your responsibility, verify they were not covered under R.C. 4123.511.
- Check Online Portals: Many insurers and the BWC provide secure online accounts. Log in to view real-time payment status, pending claims, and EOB downloads. This gives a centralized record of all transactions.
- Contact Your Employer’s Insurer: If you spot unpaid or partially paid bills, call the insurer’s claims department. Provide your claim number and copies of unpaid bills. Request written confirmation of payment status or reasons for denial.
- File a Payment Dispute: If bills remain unpaid, request a hearing through the Ohio Industrial Commission. File a motion under R.C. 4123.511 and R.C. 4123.512. A hearing officer can order payment if the insurer improperly withheld funds.
Helpful Hints
- Keep copies of all bills, EOBs, and correspondence in one folder.
- Note dates you submit bills and follow up within 30 days.
- Use certified mail or email with read receipts when sending documents.
- Ask providers to bill the workers’ comp insurer directly to avoid balance billing.
- Consider contacting a qualified attorney if disputes persist beyond 60 days.