Detailed Answer
To confirm if your workers’ compensation insurer applied payments to your medical bills under Arizona law, follow these steps:
- Request an Explanation of Review (EOR). Insurers or third-party administrators issue an EOR—also called an Explanation of Benefits (EOB)—after they process a medical claim. It shows the billed amount, allowed amount, payment amount, and any patient responsibility.
- Review Arizona’s payment deadlines. Under A.R.S. § 23-1041, insurers must pay or deny bills within 30 days of receipt. If they delay, they owe 18% interest on unpaid balances. You can view the statute here: A.R.S. § 23-1041.
- Check your medical provider’s statement. Ask your doctor or hospital for an itemized billing statement. Compare the insurer’s payment on the EOR with the amount your provider shows as paid.
- Contact your insurer or adjuster. If you haven’t received an EOR, call the claims adjuster. Ask for the payment date, amount, and how they applied it to each bill.
- Submit a written request if needed. If phone calls don’t resolve your questions, send a certified letter to the insurer requesting an EOR and billing details. Keep copies of all correspondence.
- Seek a hearing or file a complaint. If the insurer still will not provide proof of payment, you can request an informal or formal hearing with the Industrial Commission of Arizona (ICA). The ICA handles disputes under A.R.S. § 23-1063: A.R.S. § 23-1063.
Helpful Hints
- Keep all medical bills, EORs, and correspondence in one folder.
- Note claim numbers, adjuster names, and phone logs.
- Ask providers to send bills directly to the insurer.
- Check your mail and email regularly for updates.
- Act quickly—Arizona has strict deadlines for hearings and appeals.
Disclaimer: This article provides general information about Arizona workers’ compensation. It does not constitute legal advice. For guidance on your specific situation, consider consulting a qualified attorney.