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.

What Our Clients Are Saying

Excellent5.0 Based on 352 reviews from review us onsorivel gulottasorivel gulotta ★★★★★ Thank you Lauren for all of your help! You are always ready for any challenge and willing to answer any questions. Always professional, informative and kind. Will highly recommend!Janet SimoneJanet Simone ★★★★☆ TonaLaw did a great job in handling my case! I highly recommend them and would use them again if needed.Elizabeth SanchezElizabeth Sanchez ★★★★★ Definitely recommend this law firm. Great communication and walked me throughout the whole process. Very satisfied.Laurea MartinezLaurea Martinez ★★★★★ My twins and I had a bad car accident that turned our lives upside down. I was in and out of surgeries and PT to get fix. But let me tell you, TONA Law and the staff took such a stressful situations out and made everything an easy process for us! My lawyer Jeff along with Jayda and Lauren were open for communication, even if it meant answering e-mails or silly questions after hours. I highly recommended Tona Law if you are looking for a competent lawyer to fight for you! Do yourself a favor and get that “accident nuts” out of your head and give them a call. God sent!Thanks Tona Law!Joseph DadaboJoseph Dadabo ★★★★★ Tonalaw is great Lauren and Robin are such awesome people thank you guys for your helpKatelyn MccormickKatelyn Mccormick ★★★★★ I have know Lauren for years, she is a very professional and caring person, anyone working with her would be in good hands.joanne lursenjoanne lursen ★★★★★ Lauren is very knowledgeable in her field and focuses on getting the job done, producing the best results, and willing to going the extra mile.Brooke BirkeyBrooke Birkey ★★★★★ If you contact Tona Law Firm after an accident, you will be delighted to work with their team of professionals. They are caring, easy to talk to, and know how to get you quickly on the road to your best results. If you've been seriously injured in New York and you're looking for a great experience, look no further than Tona Law.jeanette devinejeanette devine ★★★★★ Lauren work ethics are exceptional. She is always extremely helpful with any questions. Tona law is very lucky to have her as part of the team.NicoleNicole ★★★★★ I have nothing but wonderful things to say about Tona Law. I highly recommend them. Dianna is amazing. She is personable, knowledgeable and extremely reliable and impressive. Thank you to the entire staff.Mike manasMike manas ★★★★★ Lauren was such a pleasure to work with! Super informative and helpful.Melanie RasmussenMelanie Rasmussen ★★★★★ I highly recommend Jeffrey Donato, personal injury attorney with TonaLaw! I've used Jeff personally, when we needed advice with two situations. He's professional, highly knowledgeable, compassionate, and responsive. I totally trust him.Educated MomEducated Mom ★★★★★ I would highly recommend Tona Law. Diana and her team are fantastic!Amazing AngelsAmazing Angels ★★★★★ They’re great team of lawyers and they really care about their clientsKaram BasraKaram Basra ★★★★★ Tona Law answered all my questions thoroughly, talked to me like I was a person and not just another case, and were dedicated to helping me solve my legal issues. Thanks to Dianna Kost and everyone on the team!Christine RoeChristine Roe ★★★★★ I would trust this firm with any matter you may have. Amazing people with great values. Plus the marketing team is killing it!anthony scottianthony scotti ★★★★★ JohnJohn ★★★★★ I have known Lauren for years. She takes pride in her work and is professional. Your in good hands with her and Tona lawErica CharleneErica Charlene ★★★★★ I have known Lauren for over 20 years, she takes pride in her work, is professional, and dedicated to helping clients. You're in good hands with Lauren on your side.emily rosenemily rosen ★★★★★ If you’re looking for superior lawyering, call tona law. I would highly recommend Dianna and her team for all your legal matters.Teresa DesimoneTeresa Desimone ★★★★★ I called Tona Law not knowing what to expect after my car accident. They were very kind and patient, made me feel very comfortable about the process while still undergoing surgeries. I know it isn't much, but when I came home from the hospital my husband showed me a little get well package that they sent. It made me feel like they cared that they went that extra step. Lauren and Jayda answered every question I had in a timely manner and if they weren't sure, one of the lawyers would call and would further explain it until I understood. Healing is already a stressful time, Tona Law made it a little bit easier. Thank you to everyone who helped.Bernhard SengstockBernhard Sengstock ★★★★★ Great people! So happy to know that they can be trusted! Will recommend! 😊👍Jeff HJeff H ★★★★★ Great experience with Tona Law. Very professional and responsive.Gisselle SortoGisselle Sorto ★★★★★ I had the pleasure of speaking with Mrs. Dianna Kost who initially referred me to TonaLaw, she was kind and very helpful! I know at TonaLaw my voice will be heard and all my questions will be answered and I will always come across a polite knowledgeable staff member. That is why TonaLaw is my ONLY choice for any Personal Injury Case I have and why I not only will recommend them to my family and friends but my patients as well. So if you are questioning which firm to pick among the the hundreds you'll find on google you might as well stop your search here and give them a call to see for yourself!Luz TursoLuz Turso ★★★★★ Dianna is honest, helpful, and exceptionally kind. It helps knowing that Tonalaw has spanish speaking attorneys and staff that accommodate the latin clientele.js_loader