July 25, 2018
The Attending Doctor's Request for Authorization and Carrier's Response (Form C-4AUTH) has been revised to remove the instruction that a Notice of Treatment Issue(s)/Disputed Bill Issue(s) (Form C-8.1 Part A) must be filed in cases where the insurer denies the request for authorization.
Per a Memorandum of Decision (MOD) in the Matter of J&A Concrete Corporation, 2017 NY Wrk Comp G1078502 (filed 9/5/2017), Form C-8.1A is no longer required to be submitted with a Form C-4AUTH Denial. The matter held:
The Board Panel finds that the carrier's denial of the request for the bone growth stimulator was a sufficient response and the failure to file a timely C-8.1A form was not ultimately dispositive under these circumstances. The C-4AUTH form was filed March 17, 2016 and the denial, along with its supporting medical opinion, was timely filed on March 29, 2016. The carrier's denial of authorization for special services must be effectuated by the timely filing of a Board-prescribed form, coupled with the timely filing of a supporting medical opinion. As the timely filing of a C-4AUTH denial, coupled with a supporting medical opinion, sets forth the carrier's objection to the special services and provides the basis for that objection, the filing of a C-8.1A form, which mirrors the C4-AUTH, is redundant and unnecessary. Therefore, the C4-AUTH denial was timely and properly filed herein.
This revision is effective immediately. Please contact Claims@wcb.ny.gov if you have any questions.
Clarissa M. Rodriguez