Confirming Application of Workers’ Compensation Payments to Your Medical Bills

Disclaimer: This article is for informational purposes only and does not constitute legal advice.

Understanding South Dakota’s Billing and Payment Rules

Under South Dakota law, employers or their insurers must pay for all reasonable medical and related expenses arising from a compensable workplace injury. See SDCL § 62-4-19 (duty to provide and pay for treatment). Medical providers bill the insurer directly, and insurers must issue payment or explain any denial promptly. See SDCL § 62-4-13 (employer’s liability for medical expenses).

Key Steps to Verify Payment Application

1. Review Your Explanation of Benefits (EOB)

Your EOB shows each medical service, the amount billed, the amount covered by workers’ comp and any patient responsibility. Look for entries marked “WC” or “Workers’ Compensation.”

2. Request an Itemized Billing Statement

Contact your medical provider’s billing department and ask for an itemized statement. This will list dates of service, charges, insurer payments and any balances you owe.

3. Contact the Workers’ Compensation Insurer

Call or email the claims adjuster handling your file. Ask for a payment ledger or transaction report showing payments made to each provider. Keep a record of the date, name of the representative and summary of your conversation.

4. Check with the South Dakota Department of Labor and Regulation

You can request assistance or file a medical fee dispute with the Division of Labor and Management if you believe payments are missing. Visit their website at dlr.sd.gov for forms and guidance.

5. Use Online Portals

If your insurer or provider offers an online account, log in to view real-time billing and payment records. Download statements for your files.

6. Compare Against Your Own Records

Keep copies of all medical bills you receive. Compare these against EOBs, statements from providers and insurer records to pinpoint any unpaid charges.

What to Do If You Spot Discrepancies

• Contact the provider immediately to confirm they sent the bill to the insurer correctly.
• Follow up with the insurer in writing, referencing the bill date and amount.
• If you still cannot resolve the issue, consider contacting the South Dakota Division of Insurance for help with insurer compliance.

Helpful Hints

• Track all dates: record when bills arrived, payments were made and follow-ups occurred.
• Keep both digital and paper copies of every statement.
• Note any denied services to see if they relate to coverage disputes or missing documentation.
• Maintain a communication log: dates, times, names of representatives and summaries.
• Know key statutes: SDCL § 62-4-19 and § 62-4-13 govern medical payment requirements.
• Don’t ignore small balances; they can accumulate interest or lead to credit issues.