Patient Information

Workers Compensation Information Sheet

icon-pdfWorkers Compensation Information Sheet

You have presented for care today indicating that you have a work related injury. The information below will be helpful to you in regards to a Workers Compensation (WC) claim.

Your Workers Compensation card and your Medical Insurance card are needed for our records. We will scan them into our computer system on your first visit.

Some services you receive will require an authorization. This should be obtained by your Physician of Record (POR) before any additional appointment. Ortho Neuro Consultants should not be your POR, we are a specialist office and therefore we can not always address all areas of your claim. In rare cases, your physician at Ortho Neuro will take on this role but please be aware this would be your physician’s decision.

If authorization is needed and not obtained prior to your visit, we will bill your private insurance company. Ortho Neuro Consultants will not request a retro authorization unless it is deemed appropriate by the Bureau. We will need to receive your private insurance information from you on your initial visit.

The Bureau of WC will only consider charges that are billed under your allowed diagnosis/condition on your claim.  If you are treated by Ortho Neuro Consultants for a non-allowed condition, your services will be billed to your private insurance.  In the event the non-allowed condition becomes allowed, we will then bill WC. Once WC pays for these services, you or your private insurance will be reimbursed.

You will receive monthly statements to update you on your account with us.  Please note that any unpaid charges are your financial responsibility.

In closing, this is being provided to you for informational purposes.  If you have any additional questions, please feel free to contact our WC department at 890-6603 or your employer.

icon-pdfWorkers Compensation Information Sheet