Form C-47 (LB-1017) Medical Payment Committee Review Request - Tennessee

What Is Form C-47 (LB-1017)?

This is a legal form that was released by the Tennessee Department of Labor and Workforce Development - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form C-47 (LB-1017)?A: Form C-47 (LB-1017) is a Medical Payment Committee Review Request form used in Tennessee.

Q: What is the purpose of Form C-47 (LB-1017)?A: The purpose of Form C-47 (LB-1017) is to request a review by the Medical Payment Committee in Tennessee for medical payment issues.

Q: When should Form C-47 (LB-1017) be used?A: Form C-47 (LB-1017) should be used when there are concerns or disputes regarding medical payments in Tennessee.

Q: What information is required on Form C-47 (LB-1017)?A: Form C-47 (LB-1017) requires information such as the claimant's name, date of injury, employer information, detailed explanation of the payment issue, and supporting documentation.

Q: How long does it take to receive a response after submitting Form C-47 (LB-1017)?A: The response time may vary, but typically it takes several weeks to receive a response from the Medical Payment Committee after submitting Form C-47 (LB-1017).

Q: Can I appeal the decision made by the Medical Payment Committee?A: Yes, if you disagree with the decision made by the Medical Payment Committee, you may have the option to appeal according to the procedures outlined by the Tennessee workers' compensation agency.