Understanding How to Verify Workers’ Compensation Payments on Your Medical Bills in Louisiana

Disclaimer: This article provides general information only and does not constitute legal advice. For personalized guidance, consult a qualified attorney.

Detailed Answer

If you receive medical treatment related to a workplace injury, Louisiana law requires your employer’s insurer to cover authorized medical expenses under LSA-R.S. 23:1201. To confirm whether those payments have been applied correctly, follow these steps:

1. Request an Explanation of Benefits (EOB) or Payment Summary

A key document is the Explanation of Benefits (EOB) or payment summary from your insurer. This statement shows:

The date your medical provider billed for services.
The amount billed to the insurer.
The amount the insurer paid.
Any outstanding balance.

Under LSA-R.S. 23:1203, the insurer must pay undisputed medical bills within 30 days of receipt. If you haven’t received an EOB within this timeframe, contact the claims adjuster or your employer’s workers’ compensation carrier.

2. Compare EOB Data to Your Provider’s Billing Statements

Obtain copies of the original billing statements from your doctor or hospital. Compare each billed service to the entries on the EOB:

Ensure dates of service match.
Verify billed codes and total charges.
Confirm the insurer’s payment aligns with the billed amount.

If you see discrepancies—such as services not listed or amounts unpaid—reach out to both the insurer and your healthcare provider for clarification.

3. Check Your Medical Provider’s Patient Ledger

Your provider maintains a patient ledger showing all transactions, including payments received from insurance. Request a copy of this ledger to see exactly when and how much was posted to your account.

4. Contact Louisiana Workforce Commission (LWC)

If your insurer fails to respond or disputes legitimate bills, you can file a claim with the LWC’s Office of Workers’ Compensation. They can investigate untimely payments or disputes under LSA-R.S. 23:1203(D). Visit the LWC Workers’ Compensation Forms page to find a claim form.

Helpful Hints

Keep detailed records: Store all bills, EOBs, and correspondence in one place.
Note deadlines: Louisiana law sets strict payment timelines—30 days for undisputed bills.
Ask for itemized bills: Ensure charges match the services you received.
Get everything in writing: Follow up phone calls with email summaries.
Consult a doctor: Verify that all treatments were authorized by your insurer.
Use certified mail: Send formal requests to your insurer to create a paper trail.
Review LSA-R.S. 23:1201 and 23:1203: Know your rights under Louisiana’s workers’ compensation statutes.

By following these steps, you can verify that your workers’ compensation insurer has properly applied payments to your medical bills and protect yourself from unexpected out-of-pocket expenses.