Tag Archives: NYCRR 325-1.25(c)

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?”