Response To Request For Award On Undisputed Facts {WC-202} | Pdf Fpdf Doc Docx | Missouri

 Missouri   Workers Comp 
Response To Request For Award On Undisputed Facts {WC-202} | Pdf Fpdf Doc Docx | Missouri

Last updated: 8/25/2023

Response To Request For Award On Undisputed Facts {WC-202}

Start Your Free Trial $ 13.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals

Description

WC-202 - HEALTH CARE PROVIDER’S RESPONSE TO REQUEST FOR AWARD ON UNDISPUTED FACTS IN REGARD TO APPLICATION FOR DIRECT PAYMENT. This form is used by health care providers in Missouri's Division of Workers' Compensation. It allows them to respond to a request for an award based on undisputed facts regarding direct payment for medical services provided to an injured employee under a workers' compensation claim. The form collects information about the health care provider, the patient, the employer, and insurer. The health care provider can present their response and attach any supporting evidence. The form also includes a certification of service and a space for Division use. It's a formal step in resolving medical fee disputes in workers' compensation cases. www.FormsWorkflow.com

Related forms

Our Products