Federal and state laws mandate that most employers provide workers' compensation insurance to cover employees for work-related illnesses or injuries. If you have an injury or illness that is work related, you must notify your employer and submit your claim to the worker's compensation carrier within the time frame specified by state law.
All claims for any insured who suffers an occupational illness or injury and whose employer is subject to the provisions of the workers' compensation law will be denied. This is true even if you fail to file a report with your employer or with the workers' compensation carrier.
When the workers' compensation carrier requires the insured to receive services from specific providers and services are received from other than a specified provider, the workers' compensation carrier is required to pay the initial $500. Blue Cross and Blue Shield of Kansas will deny claims for the initial $500. Claims for amounts in excess of the initial $500 when services were received from other than a specified provider will also be denied.
When reporting accident information to your health care provider, please be specific. If the accident is job related, tell the provider so he or she can send the claim to the appropriate insurance company for processing. If we receive a claim that lacks specific information regarding the accident, we will send you a questionnaire requesting the necessary information.
If workers' compensation denies services, a letter of release or denial from the workers' compensation carrier must be sent to Blue Cross and Blue Shield of Kansas before benefits can be considered under the insured's health insurance contract.
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