Disclaimer: This article is for educational purposes only and does not constitute legal advice. If you need help with your specific situation, consult a qualified attorney or contact the Vermont Department of Labor.
Detailed Answer
Under Vermont’s Workers’ Compensation Act, your employer’s insurer must cover all reasonable and necessary medical treatment related to your work injury. You have the right to verify that payments were properly applied to your medical bills by following these steps:
1. Request an Itemized Statement from Your Medical Provider
Ask your doctor or hospital for an itemized billing statement. This document lists each service, the total charge, any insurance payments, and any remaining balance. Review it to see whether the workers’ compensation insurer has paid the charges or if they remain outstanding.
2. Obtain an Explanation of Benefits (EOB)
The workers’ compensation insurer issues an Explanation of Benefits form when it processes a medical bill. The EOB will indicate:
- The date the insurer received the bill.
- The amount the insurer paid.
- Any portion the insurer denied and the reason.
If you have not received the EOB, request it directly from the insurer or your provider.
3. Review Vermont’s Statutory Requirements
Under 21 V.S.A. § 606(a), insurers must pay or deny medical bills within 30 days of receipt. If the insurer fails to act within that time frame, it automatically becomes liable for any unpaid amount plus interest and an administrative penalty. See the statute here: 21 V.S.A. § 606.
4. Contact the Workers’ Compensation Insurance Adjuster
If your itemized statement and EOB do not align, call the insurance claims adjuster handling your file. Provide them with the billing details and ask for a status update. Keep detailed notes of every call, including date, time, and the name of the person you spoke with.
5. File an Informal Inquiry with the Vermont Department of Labor
If the insurer still does not confirm payment, you can contact the Vermont Department of Labor’s Workers’ Compensation Division. Under 21 V.S.A. § 665, the department can conduct an informal inquiry and require the insurer to explain any unpaid bills. Visit the department’s website for instructions on how to submit your inquiry.
Helpful Hints
- Keep all medical bills, EOBs, and correspondence in a dedicated folder, either digital or physical.
- Track deadlines: insurers must respond within 30 days, or they risk penalties.
- Document every interaction: date, time, names, and a brief summary of the conversation.
- If a bill remains unpaid for longer than 30 days, follow up in writing and reference 21 V.S.A. § 606.
- Consider asking your provider to submit bills directly to the workers’ compensation insurer to avoid confusion.