Instructions This week we looked into refunds and appeals, the other side of the payment and...

Instructions

This week we looked into refunds and appeals, the other side of the payment and accounting process, which are just as important as submitting claims successfully.

Refer to Chapter 17 of the textbook to understand the rules and regulations for full payment and wait times.
Then, discuss the following questions:
- Who is responsible for the payment for a worker’s compensation case?
- Why are separate medical record necessary for these cases?

Expert Solution

Ans-1)the employees pay the premium as monthly or according to claims in insurance company.and insurance company check what are the benefits and the pay to the injured Patient.the injured Patient have benefits of Patient compensation claim benefit.

If you are worker and you received the compensation benefits, the company from which you receive your workers compensation benefits may or may not be your employer. It may be your state government, the insurance company, your employer, or the third party administrator hired by your employer to be responsible for administering the employer’s workers compensation claims.

2)in the case of insurance claims the cases are legal and insurance companies proceed after checking every minute details.

Insurance companies are use the medical records of the patient to verify the injury before they approved the additional treatment.if they doesn't show any damages, injury or severity in case deny the payment of Patient.

Insurance companies are find the medical data in regarding to your past history regarding to medical condition.insurance companies used this data to argue with patients that the medical injury are not related to accident and suspend or reject the compensation claims of worker.

That why separate medical records are Nessesary for this type of cases.

Nightingale answered 2 years ago

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