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Workers' Compensation Board

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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-718

Form HP-1, Health Provider's Request for Decision on
Unpaid Medical Bill(s) Revised

Date: September 4, 2014

As part of the Workers' Compensation Board’s effort to improve service and increase efficiency in the unpaid medical bill(s) process, Form HP-1, Health Provider's Request for Decision on Unpaid Medical Bills(s), has been revised. Form HP-1 now directs that the form is sent to the following addresses as appropriate.

When requesting an Administrative Award, Form HP-1 should be sent to the Board’s Centralized Mailing Address:

New York State Workers' Compensation Board
PO Box 5205
Binghamton, NY 13902-5205

When requesting Arbitration, Form HP-1 and a check for the processing fee should be sent to:

New York State Workers' Compensation Board
Medical Director's Office/Finance
328 State Street
Schenectady, NY 12305

The revised Form HP-1 with the new addresses may be obtained at the Board's website here or by following the link "Forms" at the top of the home page.

Please contact the Board at 1-800-781-2362 with any questions regarding Form HP-1. Thank you for your cooperation.

 

Robert E. Beloten
Chair