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If your claim is denied, no medical or compensation benefits will be paid, and the clinic that provided emergency medical care will start billing you. You must file a request for hearing within 70 days of the date of the denial letter on the form included with the denial letter. The only excuse the hearings officer can accept for not filing on time is that you can prove that you did not receive the letter and form. You must make sure that you gave your correct address on the C-4 claim form, and that you called the third-party administrator if you moved immediately after filing a claim. If you did move and have not received a denial or acceptance letter within 30 days after you first got medical care and filled out a C-4 form, call and find out if the acceptance or denial letter was sent to your correct address.
If you file an appeal from a claim denial letter, and you lose after the first hearing, you must file a further appeal with the Appeals Division within 30 days.
If the letter from the insurer says that the claim is accepted, read what the letter says about what body parts are accepted. If you injured your left wrist, but the letter says that only your left knee is accepted, you need to get an amended acceptance letter, or appeal that letter within 70 days.
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