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Health Care Providers Request Assistance with Unpaid Medical Bills

Health Care Provider

Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0)

If an insurance carrier has not paid your bill in full within 45 days of submission, you may be able to request the Board's assistance by filing Form HP-1.0 through OnBoard.

Note: Form HP-1.0 may not be submitted if less than 45 days have elapsed from the submission date of your bill or if you have received a timely Notice of Treatment Issue/Disputed Bill (Form C-8.1) from the claim administrator and the legal objection(s) related to your bill have not yet been resolved.

Once you have received access to the Medical Portal, sign into OnBoard and select Submit a Request and then Decision on Unpaid Medical Bill(s) (HP-1.0) to get started. The eForm will guide you step-by-step through the process of completing your request.

Decision on Unpaid Medical Bill(s) button in menu

How the Board resolves the unpaid medical bill will vary depending on the type of care provided and the objection(s), if any, raised by the claim administrator.

If you are an authorized provider and you have not received a timely Notice to Health Care Provider and Injured Worker of a Carrier's Refusal to Pay All (or a Portion of) a Medical Bill Due to Valuation Objection(s) (Form C-8.4), the Board will create an Administrative Award based on the applicable established New York State Workers' Compensation Fee Schedule. The claim administrator will have an opportunity to respond to this award; the Board will consider that response, and based on evidence provided, rescind or uphold the award.

If you are Board-authorized provider and you have received a Notice to Health Care Provider and Injured Worker of a Carrier's Refusal to Pay All (or a Portion of) a Medical Bill Due to Valuation Objection(s) (Form C-8.4) OR if you are not a Board-authorized provider, the objection will be resolved through a binding arbitration process; the outcome of which is final.

The Board's paper HP-1 form is no longer being accepted.

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

If the claim administrator fails to pay an administrative or arbitration award within 30 days after it is issued, you may file an HP-J1 to request consent for judgment and a certified copy of the award. These documents must be filed with the appropriate county clerk's office within 30 days following their execution.

Note: To avoid the complications of filing unnecessary requests, waiting 60 days is recommended. The 60-day time period will allow for claim administrators' billing/payment cycles.

For more information on medical bill disputes, please call 1 (800) 781-2362.

Payment for Medical Testimony

The HP-1.0 process is not appropriate for bills related to medical testimony. However, the Board may be able to assist you if you have not been paid for this service.

A medical witness is entitled to a witness fee pursuant to Part 301 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York. Within 10 days of the completion of a witness's deposition, the party responsible for such witness's fee, if any, pursuant to the Workers' Compensation Law and regulations, shall remit payment of the fee to the witness. The fee is to be awarded in like manner as a witness fee, awarded for attendance at a hearing, irrespective of the location where the deposition takes place (including telephone and video testimony). If the witness believes that a fee in excess of that set in Part 301 is warranted, such witness must submit a request to the Board within 10 days of the deposition. The Board will review such request and issue a subsequent decision concerning whether an additional fee is warranted.

If the health care provider is not paid within 10 days of the completion of a deposition, the provider should send a letter to the insurer's claim administrator stating so. The letter should include the workers' compensation case number, the date of the deposition, and a request for payment within 10 days of the letter.

If the insurer's claim administrator does not make payment within 10 days after the letter, the health care provider should send a correspondence, via hard copy or email, to the Board requesting assistance. In each correspondence, please be sure to include the following, or else the Board will be unable to take any action:

Note: Please do not include/attach any additional documents (e.g.; the subpoena that prompted the deposition, a bill for the deposition in the format of a CMS-1500 form, etc.) to the letter, as this may interfere with the processing of your request.

If you send the correspondence via hard copy, it must be sent to the Board's centralized mailing address:

NYS Workers' Compensation Board
Centralized Mailing Address
PO Box 5205
Binghamton, NY 13902-5205

If you send the correspondence to the Board via e-mail, you must include your cover letter as an attachment to your e-mail; if you include your cover letter only in the body of the e-mail it will not be properly processed. Such correspondence should be sent to the Board at wcbclaimsfiling@wcb.ny.gov.

The Board will review the request and, if it is determined to be substantiated, issue an Administrative Determination directing payment of the standard witness fee. Please note that the Administrative Determination will not provide for any additional fees.

If the claim administrator still has not made payment 30 days after the Administrative Determination, the health care provider may contact the Board by mail or e-mail to request further action.

Finally, please note that if there are multiple claims for which you are seeking a decision to compel payment, please ensure that there is a separate correspondence for each claim, and that they are not all included in the same correspondence.