Detailed Answer
Disclaimer: This is not legal advice. It provides general information on verifying workers’ compensation payments applied to medical bills under Michigan law.
Under Michigan Compiled Laws section 418.315(1), your employer or insurer must pay all reasonable and necessary medical charges related to an approved work injury. To confirm payment, follow these steps:
1. Review Your Explanation of Benefits
Your insurer issues an Explanation of Benefits (EOB) after processing a medical claim. It shows dates of service, billed amounts, insurer payments, patient responsibility, and write-offs. Request an EOB from your insurer or check your online portal.
2. Request an Itemized Medical Bill
Ask your healthcare provider for an itemized bill. It lists services rendered, charges per service, payments received, and remaining balances. Compare it to your EOB to confirm insurer payments.
3. Contact Your Employer or Insurer
If you see discrepancies, contact your employer’s workers’ compensation insurer. Provide claim details and the itemized bill to clarify unpaid amounts. Most insurers offer dedicated claim representatives to handle inquiries.
4. File a Claim with the Michigan Workers’ Disability Compensation Agency
If your insurer denies a payment or you cannot resolve the dispute, you may file a request for hearing with the Michigan Workers’ Disability Compensation Agency under MCL 418.861. The agency can order payment of disputed medical bills.
Relevant statutes:
- MCL 418.315 – Employer liability for medical benefits
- MCL 418.861 – Request for hearing
Helpful Hints
- Keep copies of all medical bills, EOBs and correspondence.
- Document dates and names when you contact your insurer.
- Ask your provider to code bills clearly with procedure codes and dates.
- Follow up in writing to create a paper trail.
- Consider seeking advice from a qualified workers’ compensation attorney if disputes persist.