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FORMS OVER SUBSTANCE:  NEW WORKERS’ COMP RULES FOR MEDICAL REPORTS AND BILLS

In many ways, the workers’ compensation system runs on medical reports. An injured workers’ proof of injury, disability, and need for treatment all depend on their doctor filling out and filing the correct form with the insurer and the Workers’ Compensation Board. For decades, those forms have been the “C-4” and “C-4.2” forms – but not anymore. As of July 1, 2022, the Board no longer accepts C-4 forms in workers’ comp cases. Instead, it now requires doctors and other health care providers to use a “CMS-1500” billing form and to attach an office note that meets the Board’s reporting requirements.

At a minimum, the office note must include:

  1. the injured worker’s temporary impairment percentage;

  2. the injured worker’s work status; AND

  3. whether the injury was a result of the work-related accident.

If the office note does not include all three of these things, then the Board may find that the report is defective. That could result in the delay or denial of necessary medical treatment, monetary benefits, or other things related to the claim.

As a result, it is important for injured workers to be sure that their doctors and other health care providers are aware of the newest workers’ comp procedures, and that their reports and bills are filed regularly, timely, on the correct forms, and include the required information.

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