‘The short answer to the question of whether a patient should continue with treatment after an IME denial, or a “cutoff” as its commonly called, is that it really depends on the medical necessity. The sole determiner of medical necessity is the treating provider.
One of the most frequently asked questions that we get in our office is, “How long can we treat for, and when do we stop treatment?”
The statute says treatment can go up to three years post-accident and is covered under no-fault insurance. My answer in every instance when it comes to a provider determining when to stop treatment is it’s up to the provider. It’s not up to the personal injury attorney. It’s not up to the insurance company or the insurance company doctors.
For the treating healthcare provider, the statutes are very favorable in terms of an analysis of whether treatment is medically necessary. The statutes are very liberally drawn to give a presumption that the treatment was medically necessary.
In short, the answer is the healthcare provider determines the medical necessity, the treatment, and when the treatment should stop.
If there is a disagreement, the dispute gets resolved by our office quickly, using the mechanisms that were put in place, mainly arbitration.
TonaLaw. You treat the patients. We do the rest.