Insurer Update Regarding Prior Authorization Requests Over $1,000

Insurer Update Regarding Prior Authorization Requests Over $1,000

As you are probably already aware, the Workers’ Compensation Board (Board) recently launched Phase 3 of our new and improved business information system, OnBoard: Limited Release (OBLR), which replaces our multiple legacy, paper-based claims systems, with a single, web-based platform.

OBLR requires health care providers to submit prior authorization requests (PARs) and requests for decisions on unpaid medical bills (formerly done via the paper Form HP-1) online.

Prior Authorization Requests Over $1,000

Workers’ Compensation Law § 13-a(5) states that specialist consultations, surgical operations, physiotherapeutic or occupational therapy procedures, x-ray examinations or special diagnostic laboratory tests costing more than $1,000 can only be denied when there is a conflicting medical opinion by a Board-authorized physician. 

The Board wants insurers to be aware that a Level 1 administrative denial in a controverted case that is filed without an independent medical exam (IME) for the above-mentioned procedures, would result in a waiver of the right to obtain an IME should the case later be established.

More Information

For questions regarding this update, please email

For information regarding the OnBoard project, you can email We also urge you to visit the OnBoard section of the Board’s website for payer overview, training and resources pages and to sign up to receive news straight to your inbox.