(a) A conditional Medicare payment may be made under either of the following circumstances:
(1) 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.
(2) The beneficiary, because of physical or mental incapacity, failed to file a proper claim.
(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part. [71 FR 9470, Feb. 24, 2006, as amended at 73 FR 9685, Feb. 22, 2008]