No Fault Litigation and Arbitration

E-mail Print PDF

The Beynenson Law Firm, P.C. represents medical and DME (Durable Medical Equipment) providers throughout New York and assists them in recovering outstanding no fault benefits.

Insurance carriers consistently and arbitrarily deny or delay claims, but in many instances such action is improper. There are many reasons insurance carriers commonly give for denials.  These include

  • lack of medical necessity based on a peer review or an IME (Independent Medical Evaluation)
  • missed IMEs
  • outsatanding verification requests
  • late claim submissions
  • EUO (Examination Under Oath) by the injured party or the provider
  • use of incorrect billing codes
  • claim amounts not in accordance with the Fee Schedule

These are just a few examples of how insurance carriers lead providers to believe they cannot recover money for the services rendered. Our firm is committed to fighting against these improper denials drawing on our experience and knowledge and finding the best strategy for each individual case.  Often, we can help you obtain the principal amount that the insurer denied.  In addition, in many cases able to recover interest that accrued due insurance company's failure to pay timely.

Our clients are always informed about their cases.  We have custom designed software to make sure all cases are processed timely and efficiently.  Clients are able to log in over the internet at any time to review all past and ongoing cases that we are handling. Features include review of paperwork for each case, quick case details, reports of closed and ongoing cases, and much more.  Of course, we are also just a phone call away and are always happy to answer clients' questions.

Litigation

For certain cases, litigation has many advantages over arbitration.  The main disadvantage to arbitration is that the rules of evidence and procedure do not have to be followed, which actually works to the advantage of the insurance carriers.  However, when an action is brought in litigation the rules are much stricter and insurance carriers are placed at a disadvantage.  Insurance carriers are aware of this and will be more inclined to settle for higher numbers when they are aware of the fact that their likelihood for success is dramatically decreased in litigation.  This is vital, as this had led insurance carriers to settle in advance of trial resulting in faster recovery.

Our litigation staff is highly knowledgeable and experienced in the law and will do everything to obtain the results you desire. In the event an insurance carrier refuses to settle at the amount you request we will take the matter to trial and oppose any issue a carrier may raise.  No case is too big, or too small.  You are entitled to recover for the vital services you have rendered. Also, there is no limit on the number of cases we can handle diligently on your behalf.

Arbitration

The American Arbitration Association (“AAA”) offers an alternative to the, at times, more expensive and time consuming litigation. According to the AAA, “For over 25 years, the New York State Insurance Department has provided consumers and insurance carriers with the opportunity for the conciliation or arbitration of disputed claims in certain automobile insurance programs. In partnership with the Insurance Department throughout those years, the AAA has administered the arbitration of such disputed claims on the Department’s behalf. The programs in which the arbitration of disputed claims has been administered by the AAA include No-Fault insurance, uninsured motorist (UM) insurance and supplemental underinsured motorist (SUM) insurance. In late 1999, at the request of the Insurance Department, the AAA also undertook the conciliation function in No-Fault insurance cases.” We will assist you in making this decision by presenting you with the advantages and disadvantages of both litigation and arbitration so that you can obtain optimum recovery on your terms.

What is arbitration?

Arbitration is a time-tested, cost-effective alternative to litigation. Arbitration is the submission of a dispute to one or more impartial persons for a final and binding decision, known as an “award.” Awards are made in writing and are generally final and binding on the parties in the case. The AAA’s arbitration services include access to its superior case management services, well-screened expert neutrals who undergo continuous training, and the AAA’s Rules and Procedures that govern the various ADR processes.

Advantages of Arbitration

According to the AAA the advantages of arbitration are:

  • Resolution in anywhere from 4 days to 4 months.
  • Enforceability of awarded claims.
  • Unparalleled customer support from filing through close of the case
  • E-filing option
  • Easy access to secure online case information
  • A confidential and neutral process
  • Your own Electronic Case Folder – an easy-to-use online tool that keeps all case-related documents in one place, regardless of what format you send them to us in

The Process

The arbitration process begins by filing a claim and filling out Form AR-1. This form can be used to request arbitration for a denied claim as well as for a delay or default in payment. In addition, using this form allows a medical-services provider to consolidate all disputed bills for the same patient in the same request. The form must be accompanied by all relevant bills and medical documentation. There is a $40 dollar filing fee. Once your file is received it is assigned to a conciliator. The conciliation period takes places prior to arbitration so settlement negotiations can take place. If the matter settles at this point it is resolved the the process ends. However, if the matter does not settle within 30 days it is assigned to an arbitrator and the binding arbitration process begins. A hearing date is assigned and within 30 days of the close of the hearing, the arbitrator renders the award.

 

If you would like The Beynenson Law Firm, P.C. to represent you in collecting your outstanding no fault claims please contact us today.

 

Contact

contact@beynensonlaw.com

516-858-4411 Tel
516-216-5405 Fax

475 Franklin Avenue
Franklin Square, NY 11010