C-8.1 Filings Updated Guidance

by Rosalind Asch-Hobeck

The Board has indicated that C-8.1 forms, used to object to medical treatment payments, have surged to nearly one million submissions annually, creating delays in resolving legitimate disputes and straining Board resources.  The insurance carriers file a multitude of C-8.1Bs that take up time for Proposed Decisions and hearings that could be better used for more important issues.  The Board is trying to simplify and modify the process.

As a claimant’s attorney, you don’t need to know the proper filing of a C-8.1 except to counter the reasons for the dispute.  Since procedures are being introduced that explain improper C-8.1 filings, this information is valuable to you as a claimant’s attorney.

Prohibited Uses of Form C-8.1B:

1. When a medical bill exceeds the fee schedule but is paid according to the fee schedule (EOB suffices).

2. For reductions in evaluations/modality payments per fee schedule ground rules (EOB suffices).

3. Duplicate bills or reconsideration requests for previously addressed bills (EOB suffices).

4. Reductions based on contractual agreements (e.g., PPO agreements; EOB suffices).

5. Following an Administrative Award via Form HP-1.0 (use HP-2 instead).

6. Objections to prior authorization decisions resolved in favor of providers.

7. Bills for treatment after an approved Section 32 agreement (EOB suffices).

Mandatory Filing Practices:

1. Clearly state valid objection reasons in Section C.

2. Only claim “controverted” status if the claim isn’t established and FROI/SROI-04 was filed.

3. Object to late bills only if submitted over 120 days post-service.

4. Include the provider's WCB Authorization # and NPI (not billing company info).

5. Attach relevant documentation, such as WCB Document IDs or supporting evidence, where needed.

6. Reference deviations from Medical Treatment Guidelines and include explanations in Box 20.

7. If Box 12 is used, provide CARC/RARC codes, descriptions, and supporting details. (These explanations are often convoluted and difficult to understand).

The Board expects the insurance carriers to follow these guidelines for filing C-8.1s to reduce the number of objections that need to be addressed in Proposed Decisions and at hearings.

The Board expects compliance and if the insurer does not comply with the guidelines and ensure that objections are reasonable and comply with Workers’ Compensation Law §13-a(6)(b), the continued misuse of Form C-8.1B could result in penalties under WCL §§13-a(6)(b) and 114-a(3).