Disclaimer: This information is for educational purposes only and does not constitute legal advice. You should consult a qualified attorney or the Wisconsin Department of Workforce Development for guidance specific to your situation.
Detailed Answer
Under Wisconsin law, employers or their insurers must pay all reasonable and necessary medical bills related to a work injury. See Wis. Stat. §102.47 for details (link). To confirm whether workers’ compensation payments were applied to your medical bills, follow these steps:
- Obtain an Itemized Medical Bill: Request a detailed statement from each healthcare provider showing services rendered, billed amounts, and any payments or adjustments.
- Request an Explanation of Benefits (EOB): Contact the workers’ compensation insurer or claims administrator and ask for an EOB. This document explains which services were covered, the insurer’s allowable amount, and any remaining patient responsibility.
- Compare Bill and EOB: Line by line, match the itemized bill to the insurer’s payment details. Ensure that the insurer’s allowed amount and payment date appear correctly.
- Review Your Records: Check your bank statements or credit card records for any payments made directly by the insurer to your provider. Look for deposits or electronic funds transfers from the claims administrator.
- Check for Liens or Subrogation Claims: Under Wis. Stat. §102.70, an insurer can assert a lien if it pays medical expenses on your behalf. Confirm that no outstanding lien balance remains on your bill (link).
- Contact the Wisconsin Department of Workforce Development (DWD): If you cannot resolve discrepancies, file a claim for a hearing under Wis. Stat. §102.16 (link) or call the DWD Workers’ Compensation Division at (608) 266-1340.
Helpful Hints
- Keep all bills, EOBs, and related correspondence organized by date and provider.
- Ask your medical provider to bill the workers’ compensation insurer directly, noting your claim number on each invoice.
- Follow up in writing if you notice unpaid balances that should have been covered.
- Use certified mail or another method with tracking when sending documents to the insurer or DWD.
- Consult the Office of the Commissioner of Insurance’s workers’ compensation resources: oci.wi.gov/WIComp.
- If you face delays or denials, consider speaking with a local attorney experienced in Wisconsin workers’ compensation law for guidance.