[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.43]



[Page 392]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

  Subpart C_Limitations on Medicare Payment for Services Covered Under 

                          Workers' Compensation

 

Sec. 411.43  Beneficiary's responsibility with respect to workers' 

compensation.



    (a) The beneficiary is responsible for taking whatever action is 

necessary to obtain any payment that can reasonably be expected under 

workers' compensation.

    (b) Except as specified in Sec. 411.45(a), Medicare does not pay 

until the beneficiary has exhausted his or her remedies under workers' 

compensation.

    (c) Except as specified in Sec. 411.45(b), Medicare does not pay 

for services that would have been covered under workers' compensation if 

the beneficiary had filed a proper claim.

    (d) However, if a claim is denied for reasons other than not being a 

proper claim, Medicare pays for the services if they are covered under 

Medicare.