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Form 112 Medical Dispute - Kentucky
What Is Form 112?
This is a legal form that was released by the Kentucky Department of Workers' Claims - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 112?A: Form 112 is a Medical Dispute form used in Kentucky.
Q: What is the purpose of Form 112?A: Form 112 is used to dispute medical bills or services in Kentucky.
Q: How do I fill out Form 112?A: You need to provide your personal information, details of the medical provider or biller, and a description of the dispute.
Q: What should I do with Form 112 once it's filled out?A: You should submit the completed form to the Kentucky Department of Workers' Claims.
Q: Is there a deadline to submit Form 112?A: Yes, Form 112 must be submitted within one year of the medical treatment or billing dispute.
Q: What happens after I submit Form 112?A: After submission, the Kentucky Department of Workers' Claims will review the form and make a determination.
Q: Can I appeal the decision made after submitting Form 112?A: Yes, you can appeal the decision by filing a written request for reconsideration within 30 days.
Form Details:
- Released on October 1, 2016;
- The latest edition provided by the Kentucky Department of Workers' Claims;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form 112 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Kentucky Department of Workers' Claims.
Download Form 112 Medical Dispute - Kentucky
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