A Week of Wins at TONALAW – No-Fault Arbitration Awards

NY CIVIL COURT ARBITRATION AWARD:  Our office recently had an arbitration award confirmed in New York Civil Court. The carrier denied lost wages pursuant to an Independent Medical Exam (IME). At the underlying arbitration hearing, the carrier argued that since the eligible injured person had not formally submitted a lost wage claim post-IME, or provided disability notes every 30 days, that she was not entitled to reimbursement. We argued that under Domotor, there was no obligation to adhere to these requirements, as the carrier had repudiated liability pursuant to the Independent Medical Exam. The Court agreed that the arbitrator made a rational determination that our client’s condition had not resolved at the time of the IME and the application of Domotor was proper, and thus reimbursement of lost wages was correct.
NY SUPREME COURT ARBITRATION AWARD: In New York Supreme Court, another arbitration award was also confirmed. This case concerned an orthopedist bill for a surgery that was denied on a peer review. The carrier argued that there was insufficient evidence in the record to establish the medical necessity of the surgery. However, the arbitrator explained what documents he reviewed and why he felt they were sufficient. As such, the award was confirmed by the Court as the arbitrator made a finding of fact.
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