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New York Carriers Request For Reimbursement of Compensation Payments Under Section 14(6) (Blue Paper)

State:
New York
Control #:
NY-C-251.2-WC
Format:
PDF
Instant download

Description

This form is an official New York Worker's Compensation form which complies with all applicable state codes and statutes. USLF updates all state forms as is required by state statutes and law.

New York Carriers Request For Reimbursement of Compensation Payments Under Section 14(6) (Blue Paper) is a form used by New York carriers to request reimbursement for payments made to employees for compensation purposes under Section 14(6) of the Workers’ Compensation Law. The form includes the name of the carrier, the date the payment was made, the amount of the payment, the name of the employee, and the reason for the payment. The form must be accompanied by the appropriate supporting documentation, such as a letter from the employee stating the amount of the payment and the purpose for the payment. There are two types of New York Carriers Request For Reimbursement of Compensation Payments Under Section 14(6) (Blue Paper): Form C-240 (Request for Reimbursement of Compensation Payments) and Form C-241 (Request for Reimbursement of Medical Payments).

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FAQ

Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.

SI-12 (7/09) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license or contract. The SI-12 must be completed by the Board's Self-Insurance Office and approved by the Board's Secretary.

Your employer must notify their insurance carrier within 10 days of the injury or illness if you require medical treatment beyond first aid or have lost at least one day from work other than the date the injury or illness occurred.

There is a statutory waiting period of seven calendar days for workers' compensation benefits. NYSIF must begin payments within 18 days after the onset of disability. Subsequent benefits are paid bi-weekly.

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

The length of time you can stay out on workers' compensation will range from 225 to 525 weeks. However, the number of weeks and amount of money you can collect from workers' comp for your work-related injury each week will vary, depending upon your individual circumstances.

The entire settlement process?from filing your claim to having the money in your hands?can take around 12-18 months depending on the details of your case and whether or not you have legal representation.

More info

Items 14 - 33 — Providers sending professional and supplier claims to Medicare on paper must use Form. CMS-1500 in a valid version.Submitted to FIs. 30.2. 3 - Effect of Payment to Ineligible Recipient. 30.2. A: When a carrier requests additional information from the treating physician or provider, the payment deadline stops. If you require assistance with completing these forms, please contact us. Should it be determined that a benefit has been paid in error, BCBSIL will request a refund of the original payment. Rule and Regulation 43, Clean Claims, and Section 14 Claims . Section 6 – Denial of Enrollment, Termination and Suspension . Refund of registration fees for motor vehicles with commercial registration unfit for use. Sec. 14-32.

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New York Carriers Request For Reimbursement of Compensation Payments Under Section 14(6) (Blue Paper)