Two separate arbitrations were filed by our office 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. 

The first claim never went to arbitration and was settled for $6,700 (including chiropractic services and testing). 

The second claim went to arbitration and the Chiropractor was awarded the full reimbursement of treatments and services $9,788.20 plus interest and attorney’s fees. 

Our firm helped this one Chiropractor recover $16,488.20 plus interest and attorneys fees for one patient’s wrongly denied chiropractic treatments.

The arbitrator decided the second claim as follows: “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 ( 2ndDept. 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 ) 

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, “ 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, 110AD2d 739, 741, ). 

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.

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.

Applicant Is Awarded Reimbursement Of $9,788.20 Together With

Interest And Attorney’s Fees.

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Excellent5.0 Based on 381 reviews from review us onJennifer CaceresJennifer Caceres ★★★★★ I highly recommend using tonalaw. Lauren and Jada are amazing. Any questions or concerns I had they answered. I am happy I choose tonalaw .Response from the ownerThank you so much for your review Jennifer! We are so glad to hear that you were pleased with our responsiveness and thoroughness in addressing your questions and concerns. Your feedback is invaluable to us, and we are committed to providing our clients with the best possible legal representation. Thank you again for your kind words. We are honored to have you as a client. Carlos UmanaCarlos Umana ★★★★★ Excelente atención buena comunicación contestan mis preguntas con sinceridadResponse from the ownerThank you so much for your review Carlos! Your feedback is invaluable to us, and we will continue to strive to provide you and all of our customers with the outstanding service you deserve. 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We are committed to providing our clients with the highest quality legal representation, and we are always striving to exceed expectations. Jennifer PorterJennifer Porter ★★★★★ Tom Tona puts so much emphasis and effort into developing a fantastic law firm, delivering excellent results for their clients and also staying at the forefront of law firm management skills. I am super impressed by my conversation and interaction with Tom and am happy to recommend him!Response from the ownerJennifer, thank you so much for this wonderful review. We are delighted to hear that you were impressed with your conversation and interaction with Tom. We strive to provide a positive and supportive experience for all of our clients, and we are so glad to hear you had such a positive interaction with Mr. Tona. Thank you again for your kind words. Janet SowinskiJanet Sowinski ★★★★★ Lauren, one of the paralegals at Tona Law is very knowledgeable, compassionate and very professional. She genuinely cares for her clients and is always willing to go the extra mile to help. Having known her for several years, i can confidently recommend both Lauren and Tona Law to anyone seeking great assistance.Carmen SandovalCarmen Sandoval ★★★★★ Quiero darles las gracias por haberme representado en mi caso, felizmente estos abogados lograron ganar ni caso, y estoy muy satisfecha por su gran trabajo, hablan español y la señorita Ana es muy atenta y cordial y amable con sus clientes, muchisinas gracias x sus servicios ademas de ser rapidos, nos ayudan mucho especialmente a las personas qué sólo hablamos español, les recomiendo este servicio de abogados muy honestos. Muchas gracias👌😘Miguel MenaMiguel Mena ★★★★★ Ana is extremely knowledgeable and a great asset to your firm! Definitely will be coming back.Sandie RivasSandie Rivas ★★★★★ Ana is amazing! Working with her was extremely enjoyable. 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He genuinely cares for others and is always willing to lend a helping hand.Response from the ownerBianca, thank you for leaving a wonderful review for our firm. We are lucky to have Will Ramos as part of our team! Arianna RamosArianna Ramos ★★★★★ Attorney Will Ramos is nothing short of dedicated and hard working. Each case he works on demonstrates his passion for law and his care for his clients.Response from the ownerThank you for your review, Arianna! Will Ramos has been a wonderful asset to our team. JenneferJennefer ★★★★★ I've had the pleasure of knowing Lauren for quite a while now, and I must say, her dedication to her clients is truly remarkable. She takes immense pride in her work as a professional she seamlessly balances her role at Tona Law, where she's involved in legal matters. Having seen her commitment and skill firsthand, I can confidently recommend both Lauren and Tona Law to anyone seeking top-notch assistance.Celine Aubry-DumandCeline Aubry-Dumand ★★★★★ I had a great experience working with TonaLaw.The team was really friendly and helpful throughout the entire process.Response from the ownerCeline, thank you so much for taking the time to leave a review for our firm. We are so grateful we were able to help you and provide you with a great experience. Thank you! Adam OmallyAdam Omally ★★★★★ I have known Lauren one of the paralegals at Tona law for many years and she is dedicated to her profession and helping her clients. Wonderful person.Alexandra DevineAlexandra Devine ★★★★★ Lauren at TonaLaw was extremely helpful! She was so nice and professional. I highly recommend asking for her!Margaret CaschettaMargaret Caschetta ★★★★★ I have known Lauren for a long time and she’s always been dedicated to her job! Excellent at anything she’s ever done.NICOLE GUASTONICOLE GUASTO ★★★★★ Lauren’s great- reliable empathetic the whole package - years of knowing her I wouldn’t ask for anyone elsejs_loader