A procedure for recovery of payment of medical bills in NY work comp exists but is little known outside of groups that handle a large volume of work comp claims.
The procedure is:
1– A bill for medical services must be sent to the correct comp carrier together with medical reports on an approved form (C-4, C-4.2, C-4AMR or C-4.3, new forms in effect since 1/1/09. After 4/1/09 all reports submitted must use these forms.)
2– If the bill is not paid within 45 days of the date sent, the medical group has 120 days, from the 45 day period, to file with the Workers’ Compensation Board Form HP-1 requesting administrative review of the bills and setting the appropriate fee.
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3– Unpaid bills may not be “bundled”. Each unpaid bill requires a separate HP-1 form.
4– C-4 reports must be attached to the HP-1. Office notes should be attached if they clarify why the services are work related.
5– If the bill has not been paid because the claim is being contested requests for payment will not be considered until a determination is made. Requests for payment, under such circumstances, may be directed to a medical plan. The plan can seek repayment from the comp carrier if the comp claim is established as work-related.
6– Payment for services will be at medical fee schedule for NY work comp claims.
This is important because employers need the cooperation of medical providers, and employees want to be assured their medical bills will be paid. The process goes much smoother when medical bills are paid on time and this procedure will help.
Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
WC Cost Calculator www.ReduceYourWorkersComp.com/calculator.php REAL COST of work comp.
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
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