Disclaimer: This article provides general information and is not legal advice.
Detailed Answer
If you received medical treatment for a work-related injury, you can confirm that your workers’ compensation insurance paid your medical bills by following these steps under Oregon law.
1. Collect Claim and Billing Information
- Find your claim number and date of injury.
- Gather all medical invoices and provider statements.
2. Request an Explanation of Benefits (EOB)
Contact your workers’ compensation claims administrator (usually the insurance company or employer-managed fund). Ask for an Explanation of Benefits (EOB) or payment summary. Under ORS 656.268(3), insurers must provide itemized payment statements showing how they applied payments to medical providers.
3. Review the Payment Details
- Match dates and codes on the EOB with your medical bills.
- Confirm that billed services are listed with corresponding payment amounts.
- Identify any unpaid charges or denials and review the reasons.
4. Check Provider Records
You can also request a detailed billing statement from your medical provider. Compare their records with the EOB to ensure proper application of payments. Under ORS 656.262, providers may request claim information to support billing accuracy.
5. Resolve Discrepancies
If you find errors or unpaid bills, contact your claims administrator. If they do not resolve the issue, you can file a complaint with the Oregon Workers’ Compensation Division at wcd.oregon.gov or request a hearing under ORS 656.321.
Helpful Hints
- Keep copies of all communications with your insurer and medical providers.
- Note deadlines: Under ORS 656.268(4), insurers must pay or deny claims within 45 days of receiving required documentation.
- Use the insurer’s online portal if available to view real-time payment updates.
- Ask your provider to bill electronically for faster processing.
- Write down names and dates when you speak to claims representatives.