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Provider Explanation of Benefits

When SORM issues a medical bill payment or denies payment of a medical bill, the Texas Workers’ Compensation Act requires SORM to provide an original Explanation of Benefits (EOB) that explains the basis for the payment determination. Generally, within two business days after payment is issued, the EOB is sent to: 1) the health care provider, 2) the injured employee, and 3) the prescribing doctor.

An EOB contains confidential information regarding a claimant’s injuries, claim status, and medical treatment. Such information is directly protected by SORM’s confidentiality statute and is exempt from unauthorized disclosure.

Any individual or entity requesting a copy of an original EOB must establish that they have a legal right to access the confidential information contained within an EOB before a request will be considered. Absent clear legal authorization to obtain a copy of an original EOB, the request must be denied.

All requests for a copy of an original EOB must be made using the form below. Requestors must pay an administrative fee and a per page fee to obtain a copy of an original EOB.

Forms and payment must be mailed to:

State Office of Risk Management

P.O. Box 13777

Austin, TX 78711