[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: 42CFR411.45]



[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. 411.45  Basis for conditional Medicare payment in workers' 

compensation cases.



    A conditional Medicare payment may be made under either of the 

following circumstances:

    (a) The beneficiary has filed a proper claim for workers' 

compensation benefits, but the intermediary or carrier determines that 

the workers' compensation carrier will not pay promptly. This includes 

cases in which a workers' compensation carrier has denied a claim.

    (b) The beneficiary, because of physical or mental incapacity, 

failed to file a proper claim.