New York No-Fault Collection Lawyer

Serving New York Healthcare Providers Since 2001

As a healthcare provider, it is your priority to provide the highest level of care and service to your patients. As you know, no-fault insurance companies make it extremely difficult to receive payments. Contrary to the original intent of the NYS Insurance Laws, many carriers look for reasons to deny claims, and sometimes even deny claims lawfully owed to you. Many healthcare providers are not aware that payments for their medically necessary services are protected under the New York State No-Fault Insurance Laws.

We want to help you get paid! According to the New York State Department of Financial Services, in most instances, healthcare providers cannot seek payment from the accident victim directly. Therefore, providers must arbitrate or litigate against No-Fault Insurance Companies to seek a judge or arbitrator’s decision mandating payment by the carrier. Our law office successfully resolves thousands of no-fault claims each year.

Let the trained professionals at The New York Personal Injury & No-fault Collections Law Firm, P.C. deal with the no-fault insurance companies while you run your healthcare business! Once a denial of your bills has been issued there is no additional risk to fighting those denials and there is no cost to you for legal fees ever.  If we are successful in disputing your claim denial with the insurance carrier our legal fee is paid by the insurance carrier, over and above your claim. If we don’t win, you don’t pay, it’s that simple.  There is no charge to you for legal fees for the collection of your improperly denied bills.

Our office filed two separate arbitrations for a Chiropractor seeking reimbursement of wrongly denied medical bills for the treatment of an injured patient under the patient’s No-Fault Insurance policy. Our firm helped this one Chiropractor recover $16,488.20 plus interest and attorney’s fees for one patient’s wrongly denied chiropractic treatments.

Arbitration Results

• Claim 1: This claim never went to arbitration and was settled for $6,700 (including chiropractic services and testing).
• Claim 2: This claim proceeded to arbitration, where the Chiropractor was awarded the full reimbursement of treatments and services: $9,788.20 plus interest and attorney’s fees.

Legal Standards & Burden of Proof

The arbitrator decided the second claim based on the following legal framework:

An Applicant establishes its prima facie showing of entitlement to judgment as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms had been mailed, received by the Respondent and that payment of no-fault benefits were overdue. Mary Immaculate Hospital v. Allstate Insurance Company, 5 A.D. 3d 742, 774 N.Y.S. 2d 564 (2nd Dept. 2004). A facially valid claim has been defined as one that sets forth the name of the patient, date of the accident, date of service, description of services rendered, and the charges for those services. (See, Vinnings Spinal Diagnostic P.C. v. Liberty Mutual Insurance Company, 186 Misc. 2d 287; 717 NYS2d 466)

Shifting the Burden

The burden then shifts to the Respondent to prove that the services were not medically necessary. Amaze Medical Supply a/a/o Bermudez v. Eagle Insurance, 2 Misc. 3d 128, 784 N.Y.S.2d 918 (2003). Once the insurer makes a sufficient showing to carry its burden of coming forward with evidence of lack of medical necessity, the applicant “must rebut it or succumb.” (See, Bedford Park Med. Practice P.C. v American Transit Tr. Ins. Co., 8 Misc. 3d 1025 (A), 2005, 2005 NY Slip Op 51282 citing Bauman v Long Island Railroad, 110 AD2d 739, 741).

The Arbitrator’s Analysis

As a general rule, reliance on rebuttal documentation will be weighed in light of the documentary proofs and arguments presented at the arbitration. Moreover, the case law is clear that a provider must rebut the conclusions and determinations of the IME doctor with his own facts. Park Slope Medical and Surgical Supply, Inc. v. Travelers Ins. Co., 37 Misc.3d 19 (App. Term 2d, 11th & 13th Dists. 2012).

Following a thorough review of all the medical documentation submitted in this matter—which includes all physician evaluations, follow-up reports, and the IME report—I find these physicians are in direct contradiction to one another. I am, of course, mindful that each of these experts has a distinct interest and/or possible bias for his or her conclusions. That being said, the Applicant contends that the services rendered were medically necessary; the Respondent contends otherwise. The Arbitrator is thus placed in the position of determining which of these opinions (both of which on the surface appear credible and cogent) should be accorded the most weight.

The Decision & Award

Here, there is extensive diagnostic testing of this EIP which demonstrate, among other things, disc herniation at L3/L4, L4/5 with impingement of the ventral thecal sac on both, along with significant cervical findings.

The IME examiner, on the other hand, has positive findings upon testing EIP’s range of motion, both cervical and lumbar, and he reviews the positive MRIs—all of which he ignores in deciding that EIP requires no further treatment. The applicant examines EIP the following day and also finds significant restrictions in ROM.

The Result

Applicant Is Awarded Reimbursement Of $9,788.20 Together With Interest And Attorney’s Fees.