Insurers Request For Reconsideration Of Reduction Under WCL § 14(6) Or 15(8) {C-251.6}

C-251.6 - INSURER'S REQUEST FOR RECONSIDERATION OF REDUCTION UNDER WCL SECTION 14(6) OR SECTION 15(8). Submission of this form is a certification to the Chair of the Workers' Compensation Board that the amount of reimbursement requested is the same as that which was expended, that all payments were made in accordance with the applicable medical fee schedule and Medical Treatment Guidelines, that no part thereof has been previously reimbursed, that the amount stated herein is due and owing, and that the information contained herein is true and correct. Invalid or inaccurate requests may be subject to penalty. www.FormsWorkflow.com