Form C-8.4 Notice to Health Care Provider and Claimant of an Insurer's Refusal to Pay All (Or a Portion) of a Medical Bill Due to Valuation Objection(S) - New York

What Is Form C-8.4?

This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on July 1, 2022;
• The latest edition provided by the New York State Workers' Compensation Board;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of Form C-8.4 by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.