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Application for Fee Review, LIBC-507, Form Tutorial

A provider who has submitted required bills and reports to an insurer and who disputes the amount or timeliness of a payment made by an insurer may ask the bureau to review the fee dispute. The provider or their attorney must file an Application for Fee Review, LIBC-507. Click here for instructions on completing this form.

Medical Report Form, LIBC-9, Tutorial

A Medical Report Form, LIBC-9, is required to be submitted to the employer or insurer within 10 days of initial treatment of a work-related injury and monthly thereafter as long as treatment continues. This form must be accompanied by documentation to support the billing. Click here for instructions on completing this form.
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