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Workers’ Compensation Board

WCB Information Related To Novel Coronavirus (COVID-19)

Forms and Processes

Forms and Processes Associated with Medical Treatment Guidelines
Process Form Title Initiated by Response by and when Response Form Denial review requested by Denial Resolution
Optional Prior Approval MG-1

(MG-1.1 may be attached)
Attending Doctor's Request for Optional Prior Approval and Carrier's/Employer's Response

(Continuation of...above form)
Medical Provider
(not OT/PT)
Carrier – 8 days MG-1 Medical Provider - within 14 days Informal – between MP and Carrier or Medical Director's Office
Variance Request MG-2

(MG-2.1 may be attached)
Attending Doctor's Request for Approval of Variance and Carrier's Response

(Continuation of …above form)
Medical Provider
(not OT/PT)
Carrier – 15 days or, if notify of IME within 5 days, then 30 days MG-2 Injured worker – within 21 days Medical Director's Office unless Carrier or Claimant/Claimant Attorney request an expedited hearing
(Required) Pre-Authorization C-4AUTH Attending Doctor's Request for Authorization and Carrier's Response Medical Provider Carrier – 30 days with IME C-4AUTH automatic Expedited hearing
Administrative Award Request HP-1
Part A
Health Care Provider's Request for decision on Unpaid Medical Bill(s) Medical Provider - 45 days after bill if no response N/A HP-2 Carrier may object Disputed Bills Unit
Objection to Bill on MTG Issues C-8.1
Part B
Notice of Treatment Issue(s)/Disputed Bill Issue(s) Carrier WCB Adjudication N/A N/A WCB Hearing or Conciliation
Objection to Bill for Valuation Issues C-8.4 Notice to Health Care Provider and Injured Worker of a Carrier's Refusal to Pay All (or a Portion) of a Medical Bill Due to Valuation Objection(s) Carrier Medical Provider Arbitration Request on HP-1 Part B N/A Arbitration Panel