20 Cfr 61.101

20 CFR 61.101 - Filing a request for reimbursement.

• Section Number: 61.101

• Section Name: Filing a request for reimbursement.

(a) A carrier or employer may file a request for reimbursement. The

request shall be submitted to the U.S. Department of Labor, Office of

Workers' Compensation Programs, Branch of Special Claims, P.O. Box

37117, Washington, DC 20013-7117;

(b) Each request for reimbursement shall include documentation

itemizing the payments for which reimbursement is claimed. The

documentation shall be sufficient to establish the purpose of the

payment, the name of the payee, the date(s) for which payment was made,

and the amount of the payment. Copies of any medical reports and bills

related to medical examination or treatment for which reimbursement is

claimed shall also be submitted. If the carrier cannot provide copies of

the payment drafts or receipts, the Office may accept a certified

listing of payments which includes payee name, description of services

rendered, date of services rendered, amount paid, date paid check or

draft number, and signature of certifier.

(c) When filing an initial request for reimbursement under the Act,

the carrier shall submit copies of all available documents related to

the workers' compensation case, including--

(1) Notice and claim forms;

(2) Statements of the employee or employer;

(3) Medical reports;

(4) Compensation orders; and

(5) Proof of liability (e.g., insurance policy or other

documentation).