Tag Archives: C-8.1

Friday F.A.Q. “Why are so many C-8.1s being resolved in favor of the providers even when there is a legitimate reason to deny the treatment or bill?”

Tashia Rasul, Esq.
Tashia Rasul, Esq.
Many C-8.1s are resolved in favor of the providers because they are defective, meaning the C-8.1s are not properly completed or timely filed.

Part A Defenses.

The C-8.1 form is divided into two Parts: A and B. Part A requires the carrier to specify the legal reason for its objection to treatment, and to provide information on its conflicting medical evidence, that is, an IME or Peer Review Report. If treatment is being objected to, the carrier must notify the claimant, provider and Board within five days of the objection (e.g. denial of a C-4AUTH request). If the carrier is asserting that the basis for the objection is conflicting medical evidence, such evidence must be supplied with the C-8.1, or if already in the Board file, identified using the Board document identification number. Further, the carrier must provide proof of mailing of notice to the claimant, his attorney and his doctor. See NYCRR 300.23(d). Continue reading Friday F.A.Q. “Why are so many C-8.1s being resolved in favor of the providers even when there is a legitimate reason to deny the treatment or bill?”

C-8.1s: Effective Denials of Treatment and Bills For Treatment

Tashia Rasul
Tashia Rasul, Esq.

The employer or insurance carrier is responsible for all medically necessary treatment to the claimant, and payment of same, when a claim has been accepted or established by the Board as compensable. See NYCRR Section 325-1.25. When treatment is not medically necessary, the carrier can object to same using the Board-C-8.1 forms. However, if the objection is improper, the carrier will likely be found liable for significant unnecessary medical costs, and therefore face increased expenses.

The C-8.1 forms are straightforward. However, they are often resolved in favor of the medical providers because they are not properly completed or timely filed. Continue reading C-8.1s: Effective Denials of Treatment and Bills For Treatment