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Get Ny Hp-1 2014

Passed attached medical bill(s). A copy of the carrier's payment explanation since the date of the medical bill submission or more than 30 days from must be attached. If you wish to submit other documents to be the receipt of a related notice establishing carrier/employer liability. considered by the Arbitrator/Panel, attach them to this form. Complete Complete the front of this form and Section A on the reverse. the front and reverse of this form. SEE TABLE OF ARBITRATION FEES FEE IS NOT REQUIR.

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