Detailed Answer
Please note: This information is for educational purposes only and does not constitute legal advice. Always consult a licensed attorney for guidance on your specific situation.
1. Understand Your Rights Under Idaho Law
Under Idaho Code §72-306, your employer or its insurer must pay all reasonable and necessary medical expenses related to a work injury. Idaho Code §72-432 further requires timely payment of compensation and related medical bills by the insurer. You have the right to receive an Explanation of Benefits (EOB) or an account statement showing how payments were applied to each medical service.
2. Request an Explanation of Benefits (EOB)
- Contact the workers’ compensation insurer or third-party administrator handling your claim.
- Ask for an EOB or a payment ledger that details each medical bill, the amount billed, the amount paid by the insurer, and any remaining balance.
3. Review Medical Provider Statements
- Obtain copies of all invoices or statements from your healthcare providers.
- Compare those invoices to the insurer’s EOB to confirm which charges were paid.
- If a bill remains unpaid, note the dates and amounts so you can follow up.
4. Examine Claim Filings and Correspondence
- Review any letters or emails from the insurer regarding payment of medical expenses.
- Keep a copy of your claim file request under Idaho Code §72-332, which allows you to inspect records related to your claim.
- If you notice discrepancies, send a formal written request to the insurer for clarification.
5. Contact the Idaho Industrial Commission
If the insurer fails to respond or you cannot reconcile your bills, you can file a complaint with the Idaho Industrial Commission. The Commission can investigate late or disputed payments under Idaho Code §72-432.
Helpful Hints
- Keep detailed records of all medical treatment dates, provider names, and billed amounts.
- Organize paperwork chronologically to simplify comparison between provider invoices and insurer statements.
- Follow up promptly: Idaho law requires insurers to pay undisputed bills within 21 days of receipt.
- Use certified mail for written requests to create a clear paper trail.
- Consult the Idaho Industrial Commission’s website for forms and guidance: iic.idaho.gov.