Publications and Forms
A form for use by a health care provider to apply for direct payment in regards to a workers' compensation medical fee dispute—if the health care provider believes that it can show that it was authorized to treat the employee but no payment has been made.
A form for use by a health care provider, an employer or an insurer to request an evidentiary hearing in regards to a workers’ compensation medical fee dispute.
A form for use by health care provider applying for payment of additional reimbursement of medical fees in a workers’ compensation medical fee dispute —if a partial payment has been made. (These are called “reasonableness” cases.)
A bi-weekly form to be completed by the healthcare provider to provide dates of physical rehabilitation treatments for an injured worker eligible for the physical rehabilitation benefit through the Second Injury Fund.