Disclaimer: This article provides general information and does not constitute legal advice.
Detailed Answer
After a workplace injury, West Virginia law requires your employer or its insurer to pay for your medical treatment as long as it qualifies under workers’ compensation rules. Under WV Code §23-4-5, covered treatments include reasonable and necessary medical care related to your injury.
Why Verify Payment Applications?
Ensuring your medical providers receive correct payment prevents unexpected bills and protects your claim’s integrity under West Virginia workers’ compensation law.
To confirm that payments were applied to your medical bills, follow these steps:
- Obtain Explanation of Benefits (EOB): Request an EOB from the workers’ compensation insurer. This document shows which provider bills were paid, denied, or pending.
- Review Provider Statements: Compare your EOB with statements from your medical providers. Ensure the dates, services, and amounts match the insurer’s records.
- Check Employer or Insurer Records: Use your employer’s claims portal or call the insurance adjuster. Ask for a payment summary for your claim.
- Use State Resources: The West Virginia Bureau of Employment Programs offers an online claim portal for status updates. You can see payment history and outstanding balances.
- Contact the WV Workers’ Compensation Division: If you can’t resolve discrepancies, call 1-800-642-7236 or email wvbep-adjudication@wv.gov for assistance.
If you suspect your bills were not paid properly, you may request a formal review or file a complaint with the Office of Judges under WV Code §23-4-7.
Helpful Hints
- Keep all bills, EOBs, and correspondence organized.
- Note claim numbers and adjuster names for reference.
- Follow up promptly on any unpaid bills to avoid collection issues.
- Document phone calls: date, time, and person spoken to.
- Consult an attorney if you face repeated denials or delays.