A lot of our clients are confused by the same thing: an envelope from the Workers' Compensation Board with a decision they never saw a hearing for, or a form with a dollar amount on it that looks like a medical bill.
Here is what those papers are, and what — if anything — they mean you need to do.
What a Proposed Decision Is
You may get papers from the Board with one of these at the top:
- Notice of Proposed Conciliation Decision (the Board's code for it is PDNSL)
- Administrative Decision
Either way, these are proposed decisions. They are decisions the Board makes without a hearing, and they are not final until a date printed on the decision.
For example, you might get a decision dated August 9 that says it becomes final on September 15 — unless one of the parties objects first.
How an Objection Works
Until that date, both you and the insurance carrier have the right to object. The decision has space on the back to write that you object and state the reason.
If either side objects, for whatever reason, the proposed decision is cancelled and the Board takes other action. It might:
- schedule a hearing to deal with the issue, or
- issue an amended proposed decision or an amended administrative decision.
If the date passes and nobody objects, the decision becomes final — and it counts just as though a judge had made that decision at a hearing.
Most Proposed Decisions Are About Medical Bills
A proposed decision can contain almost any finding a judge could make. But most commonly, they deal with your doctor's bills — and the insurance carrier's objections to them.
When the carrier receives a bill from your doctor and does not want to pay it, it objects on a form called the C-8.1. The form lists many possible reasons for the objection. For example:
- The treatment is not related to your case — it is for an injury or illness that is not part of your claim.
- The treatment was not authorized. Physical therapy is a common example: you get a certain number of visits, and once your injury is established, the carrier's approval can be needed for more. If that approval was not obtained, that can be a basis for an objection.
There are many other reasons a carrier might give.
You will get a copy of the C-8.1 and a copy of the proposed decision that resolves it:
- Found in favor of the provider: good news for your doctor. The carrier now has to pay the bill your doctor submitted.
- Found in favor of the carrier: the carrier does not have to pay that bill.
(You may also see a C-8.4. That one is different — it is about how much the carrier has to pay, not whether it has to pay at all.)
Does That Mean You Have to Pay the Bill?
In most cases, no.
If the injury or the treatment is established in your case — meaning the carrier has already been found liable for it — then even when the C-8.1 is decided in the carrier's favor, you still do not have to pay that bill. In that situation, your doctor generally has to absorb the cost.
So when you see a C-8.1 with a dollar amount and an objection on it, do not assume it is a bill being sent to you. You are copied on it because the carrier has to send you a copy. It is not addressed to you, and it is not asking you to do anything.
Your attorney can tell you whether the treatment in question is part of your established case.
If You Have an Attorney, This Is Their Job
If you have a workers' comp attorney — whether it is us or anyone else — your attorney gets a copy of the same papers you get. If the proposed decision goes against you and there is a ground to object, your attorney will object on your behalf.
Getting a copy in the mail does not make the deadline your problem. You do not need to stay up at night worrying about the date printed on the page.
Key Takeaways
- A Notice of Proposed Conciliation Decision or Administrative Decision is a Board decision made without a hearing, and it is not final until the date printed on it
- If either side objects before that date, the decision is cancelled and the Board takes other action; if nobody objects, it becomes final like any judge's decision
- A C-8.1 is the carrier objecting to your doctor's bill — not a bill to you
- If the injury or treatment is established in your case, you generally do not have to pay the bill even when the carrier wins the objection
- If you have an attorney, they get the same papers and will object when there is a reason to
Got something from the Board and not sure what it means?
Workers’ compensation is what we do. At Schotter Millican, LLP, we represent injured workers across New York City, and we have never represented an insurance company or carrier.
Call (718) 770-3708 for a free case review. No fee unless we win.
Hablamos español — llame al (718) 770-3708.
Mówimy po polsku — zadzwoń (718) 770-3708.