Q: How long after you settle the WC case does the ins comp have to pay outstanding med bills?

A: Medical bills must be submitted for payment using the appropriate billing forms with attached treatment records before the carrier has an obligation to pay. Simply sending the invoices or collection letters is not enough. Once the proper documents have been submitted, the carrier has 30 days to make payment.

In this type of situation, I would normally confirm that the medical providers have the correct billing information and that the bills have been submitted for payment on the proper forms. Assuming that has happened, I would then determine whether the carrier denied the bills, ignored the bills or made a partial payment. If a payment was made, the medical provider cannot pursue the injured worker for the difference. The provider would either have to accept the payment or file a fee review. I am assuming that the medical provider is a PA provider; if the provider is out of state the rules are different. If the bill has been denied or ignored, a Petition for Penalties may be appropriate.

Finally, if the carrier has submitted the bills for utilization review, they are not required to make payment until the utilization review is complete. If the utilization review finds the treatment to be unreasonable or unnecessary, the carrier will not have to make payment unless this determination is challenged through a Petition to Review UR.

If you were represented in your settlement, you should talk to your lawyer. If you were not represented, you have a great deal of leg work to do.