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What is an Explanation of Benefits (EOB)?

Travelers is an insurance company that often sends out a document called Explanation of Benefits in it Georgia workers’ compensation claims.  I have include an example of the pages of a sample Travelers Explanation of Benefits document below with the identifying information removed:

Travelers Explanation of Benefits_Page_1A document that explains how the Explanation of Benefits worksTravelers Explanation of Benefits_Page_3
Travelers Explanation of Benefits_Page_5Travelers Explanation of Benefits_Page_6

If you receive one of these documents, you may have questions about whether there is anything you need to do.  This article will attempt to shed some light on what these documents mean and what you should do when you receive them.

What does an Explanation of Benefits mean?

At its basic level, the Explanation of Benefits (otherwise known as an EOB) provides information about medical bills that the insurance company is paying.  Georgia law requires your employer and their workers’ compensation insurance company to pay for certain medical treatment that you need as a result of your work injury.  The Explanation of Benefits form will tell you the amount the medical provider billed for the medical treatment and the amount that the insurance company actually paid for that treatment.

Sometimes, the insurance company gets to pay less than what the medical provider bills for the treatment because medical bill payment in Georgia workers’ compensation cases is controlled by a medical fee schedule.  This fee schedule limits the amount that the insurance company must pay for treatment.

Am I responsible for paying a copay or deductible if the workers’ compensation insurance company does not pay the full amount billed?

NO! Georgia workers’ compensation law provides that you are not responsible for paying any co-pays or deductibles for the medical treatment for your work injury.  You do have to follow certain rules about the medical providers who can provide you treatment and what treatment is covered.  But, if your treatment is authorized treatment for your injury, the insurance company pays the entire cost of the treatment and the medical provider cannot recover anything from you.

Sometimes, a medical provider may attempt to send you a bill for an amount that the insurance company did not pay.  However, even if the insurance company did not pay the full amount billed by the medical provider, you are not responsible for paying anything for the treatment.  In these situations, either the insurance company did not pay the correct amount and should pay the remaining balance or the insurance company paid the correct amount under the fee schedule and the medical provider has to write off the rest of the billed amount.  Either way, you do not have to pay anything.

Do I have to do anything if I receive an Explanation of Benefits from Travelers or some other insurance company?

No. You do not have to do anything. There is no paperwork you are required to file.  There is no one that you have to call.  The EOB form should simply be telling you that your medical treatment has been paid.

Although there is nothing you have to do, there is one thing that you should do.  You should take this opportunity to find more about the Georgia workers’ compensation laws about medical treatment and other benefits.  If you do not know know about the workers’ compensation law in Georgia or have someone representing you who does, you will likely run into problems in your case.

A good starting point for getting some important information is our blog article Eleven Things You Should Know about your Georgia Workers’ Compensation Case It will provide you with some important information about medical treatment and other Georgia workers’ compensation benefits.

If you want more information, our attorneys also post videos about specific workers’ compensation topics on our Perkins Studdard YouTube page.  If you have specific questions, the best way to get them answered is to ask one of our attorneys directly.  We would be happy to talk to you and answer your questions.  Some people are concerned about the cost of talking to an attorney.  If you are, you can find out more about getting a free consultation and even what it would cost if you decided to hire us by reading this article.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families. To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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Jason Perkins

Workers' Compensation Attorney

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