In recent months, our office has seen numerous instances in which claimant law firms successfully challenged C-8.1B denials based on improper service, regardless of the sufficiency of the underlying denial basis.
The relevant statute, 12 NYCRR 325-1.25(c)(1), provides that the carrier “shall” notify both the claimant and the claimant’s attorney that a medical bill is not being paid, as well as the reason for non-payment.
Although Form C-8.1B is not clear and does not include a designated area for serving claimant’s counsel, every C-8.1B and all attachments—including narratives, bills, and related materials—must be copied to claimant’s counsel.
To help establish proper service, we strongly recommend sending claimant’s counsel a copy by electronic service, such as email, when available. This creates correspondence that can be produced as affirmative proof of service if the issue is raised at a hearing.
While this may add an extra step, we encourage our clients to follow these procedures to avoid paying denied bills that may otherwise have been upheld. As always, we are happy to answer any questions, address concerns, or provide additional guidance going forward.
