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Form Focus: N.Y. Carrier’s Request for Reconsideration of Reduction

09 Feb, 2024 Frank Ferreri

new york 31503 640
                               

Albany, NY (WorkersCompensation.com) -- When an insurer seeks a reconsideration in New York, there's a form for that. It's the C-251.6.

Here's how it works.

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RequirementsExplanations
CertificationsWhen a carrier submits a C-251.6 it certifies that:
1. The amount of reimbursement requested is the same as that which was expended.
2. All payments were made in accordance with the applicable medical fee schedule and Medical Treatment Guidelines
3. No part has previously been reimbursed.
4. The amount stated is due and owing.
5. The information is true and correct.
Submission InformationInsurer ID (W Number). The WCB-assigned Insurer Code ("W Number") for the insurer that is responsible for the claim and seeking reimbursement; this entity must be identified as a Party of Interest (POI) on the claim in the WCB case folder in
order for reimbursement to be processed.
Insurer Name. The form will populate the name of the insurer that is responsible for the claim and seeking reimbursement from the name in Groups tab.
Claim Administrator. The name of the entity that is administering the claim and will receive the reimbursement or indicate if claim is self-administered; this entity must be identified as a POI on the claim in the WCB case folder in order for reimbursement to be processed. Payment will be directed to the address the WCB Special Funds Group has on file for the administrator.
Contact Name. Enter the name of the person that the WCB Special Funds Group can contact with questions about the submission.
Phone Number. The phone number for the contact.
Email Address. The email address for the contact.
Submit Date. The date the form was submitted to the WCB Special Funds Group.
Claim InformationWCB Case Number. The claim number assigned by WCB; this number should be entered as it appears in eCase with no spaces or extra characters.
Claim Admin Claim Number (optional). The claim number assigned by the entity that is administering the claim.
Claimant Name. The name of the claimant.
Request SummaryReference Number. The reference number assigned to the original request by Special Funds Group. This number appears on Form C-251R and Form C-251.1R.
Begin Date. The begin date of the original request.
End Date. The end date of the original request.
Original Amount. The amount of the original request.
Requested Amount. The amount that reconsideration is being requested for; this amount cannot be greater than the difference between the amount of the original request and the amount that was approved by Special Funds Group for that request.
Instructions for Making the RequestProvide a brief statement of the particular grounds upon which the request for reconsideration is based. A one-page document may be attached as an addendum, using 12-point font, with 1-inch margins, on 8.5-inch by 11-inch paper. An addendum longer than one page will not be considered, unless the insurer specifies in writing, why the basis of the request could not have been made within the space provided and the one-page addendum. Additional supporting evidence may be submitted if such evidence has not been submitted previously and is not already available for consideration in the Board's electronic case folder.
The number of additional documents submitted shall not exceed the number of medical bills at issue and/or, more than 10 pages where the request involves indemnity reimbursement.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law.

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