Publications and Forms
A form to be completed by the employer or insurer responding to the application for payment of additional reimbursement of medical fees (a “reasonableness” case).
A form which may be completed by a health care provider, an employer or insurer in a “reasonableness” medical fee dispute where the amount in dispute does not exceed $1,000.
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.)
Some employers ("lessors") lease employees to clients. Unless the lessor provides a financial guarantee, such as posting securities, to ensure prompt payment of unemployment liabilities: (1) the lessor must file a separate Quarterly Contribution and Wage Report for the employees leased to each client; and (2) the client is jointly liable for the contributions otherwise due on the workers it leases from the lessor. MODES-4251 must be used for the posting of securities.