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Workers’ Compensation Board

Filing a HP-1 or HP-J1 Form with the Workers' Compensation Board

HP-1 Form: Request for Decision on Unpaid Medical Bill(s)

The HP-1 request form should be submitted when the health provider has been unsuccessful in obtaining payment from a carrier for services rendered to a patient who has a Workers' Compensation case. (Please see information below regarding the HP-J1 Form which should be used when a provider has not been paid after an administrative award or arbitration decision was made.)

Note: A minimum of 45 days must elapse after submission of the medical bill to the carrier before the HP-1 Form can be submitted. The Board suggests waiting 60 days because some carriers make their payments on that cycle.

There are two paths to the resolution of an unpaid bill.

[Box A] Request for Administrative Award is used when an insurance carrier has not responded to your bills with a written objection within 45 days.

Note: If the medical bill(s) was for one of the following types of care: Ambulance, Audiology, Dental, Durable Medical Equipment, Laboratory, Optometry, Other, Out of State or Pharmacy, the HP-1 MUST be submitted to Arbitration, even if the insurance carrier or self-insured employer did not notify of an objection to the bill.

[Box B] Request for Arbitration is used when an insurance carrier or self-insured employer has responded to your bills with a timely (45 days) written objection raising valuation/arbitration issues on a C-8.4 form.

Recommendations:

  1. Follow the very specific time limits for filing.
  2. Fill out the HP-1 form completely along with all necessary attachments.
  3. If you receive a C-8.1 (Disputed Medical Bill) or Denial of Claim from the insurer, it means there are legal issues pending. You must wait for a decision by a Board judge before requesting arbitration or an administrative award.
  4. If you receive payment for your bill(s) after filing for arbitration, please submit an HP-4 withdrawal form adobe pdf.

HP-J1 Form: Provider's Request for Judgment of Award, Section 54–b, Enforcement on Failure to Pay Award or Judgment

The HP-J1 Form should be submitted when an authorized workers' compensation provider has not been paid for an administrative award or arbitration decision made on or after March 13, 2007. The provider must wait at least 30 days from the issuance of an administrative award and/or arbitration decision before requesting consent for judgment of the award. To avoid the complications of filing unnecessary requests, waiting 60 days is recommended. The 60 day time period will allow for carriers' billing/payment cycles.

Note: The consent to file and certified copy of the decision that awards compensation must be filed with the appropriate county clerk's office within 30 days following the execution of the document.

For more information on the HP processes, please call 1(800)781-2362