EMPLOYER ONLINE TREATMENT AUTHORIZATION 

Required for all services 


We authorize COMPCARE to provide treatment to our employees for work-related services, injuries or illnesses. By doing so, we acknowledge that if the claim is denied by our insurance carrier, we will notify COMPCARE of the denial but remain responsible for payment for all services rendered and any medically-necessary items dispensed, as long as such treatment or items are for work-related services, injuries or illnesses. Employer is not responsible for payment for treatments rendered to patients that are not for work-related services, injuries or illnesses. Patient, and not employer, shall be fully responsible for payment for non-work related treatment or services provided by COMPCARE.