Title: Employer risk adjustment
Corr #:
Purpose of correspondence: This letter is used to respond to an employer’s request to have medical payments adjusted from a claim’s costs.
Addressee: Employer
Copied to: Employer Rep.
Processing Instructions: This letter is copied and pasted into a V3 ad hoc letter and will be printed on the current letterhead using the standard V3 header and footer.
This letter is in response to your recent <inquiry, Motion (C-86), or letter> about crediting your policy for medical payments in the above claim.
Insert 1<Based on our research, we paid the medical payments in question appropriately and we will charge them to your policy.>
Insert 2<Please be advised that we will make an adjustment on your policy. We will notify you in writing when this happens.>
Insert 3<Please be advised that you may receive credit only for payments made for medical treatment and/or services that we determined to be inappropriate or no longer medically necessary from the date we make our decision into the future. We will not make adjustments for medical treatment and/or services rendered prior to the date of the decision unless-
· The claim is denied in its entirety,
· A condition in the claim for which the treatment or services are rendered is denied
· The Industrial Commission of Ohio (IC) orders denial of the treatment.>
Insert 4<Free Form Text>
If you disagree with this decision, please file a Motion (C-86) with the following language, “Employer requests the IC deny medical treatment and/or services rendered for the period prior to the decision issued by BWC due to following reason ______.” As with the filing of any C-86, you must attach substantial competent proof supporting your request. Please do not use “credit risk” language in the C-86 as the IC has no jurisdiction to hear matters of risk and, therefore, will not schedule it for a hearing.
Please contact your assigned claims service specialist if you have any questions about the information in this letter. Thank you.