Special Funds Group (SFG) Reimbursement
Step 1
Before submitting a reimbursement request the insurer or self-insured employer (SIE) must have an Statewide Financial System (SFS) account.
5-10 days
Step 7
SFG sends final determination
- C-251.6R
- All SFG responses are subject to audit by Office of State Comptroller (OSC)
30 days
Step 8
Insurer submits request for review of SFG final determination
- RFA-2 and all necessary evidence as required in SN046-1063R dated 11/16/2021, within 30 calendar days.
| Number | Name |
|---|---|
| C-251 | Insurer's Request Reimbursement of Indemnity Payments Under WCL Section 14(6) or Section 15(8) |
| C-251C* | SFG Receipt of Form C-251 |
| C-251N | Insurer's Notification of Initial Request for Reimbursement Under Section 14(6) or Section 15(8) |
| C-251R* | SFG Response to Form C-251 |
| C-251.1 | Insurer's Request for Reimbursement of Medical Payments Under WCL Section 15(8) |
| C-251.1C* | SFG Receipt of Form C-251.1 |
| C-251.1R* | SFG Response to Form C-251.1 |
| C-251.6 | Insurer's Request for Reconsideration of Reduction Under WCL Section 14(6) or Section 15(8) |
| C-251.6C* | SFG Receipt of Form C-251.6 |
| C-251.6R* | SFG Response to Form C-251.6 |
| RFA-2 | Request for Further Action by Insurer/Employer |
* These forms are sent by the Special Funds Group.
RFA-2 Evidence
When seeking review of the Special Funds Group Decision Form C-251.6R, the insurer must also submit the following forms and emails with Form RFA-2. New evidence may not be submitted with the Form RFA-2, and will not be considered by the WCLJ:
- The Special Funds Group reconsideration response (Form C-251.6R) and the email from the Special Funds Group with Form C-251.6R attached.
- Form C-251.6 and the email from the insurer attaching Form C-251.6.
- Prior Special Funds Group response (Form C-251R or C-251.1R) and the email from the Special Funds Group with Form C-251R or C-251.1R attached.
- Any email receipts from the Special Funds Group acknowledging that the request for reimbursement was submitted and the dollar amount accepted by the Special Funds Group.
- Any relevant emails, including the email sent by the insurer with Form C-251 or Form C-251.1 attached.
- Form C-251 or Form C-251.1.