No-Fault Collections for New York Healthcare Providers
Beynenson Law represents New York healthcare providers in collecting no-fault insurance claims that insurers have denied, delayed or paid only in part. We handle a claim from billing through arbitration, court and appeal, and we decide how to pursue each one with our own billing software and with data on how arbitrators, insurers and courts decide.
Talk to us about your claims: call 347-746-6001, email contact@beynensonlaw.com or send us a message through our contact form.
Who we represent
- Medical practices: physicians, orthopedics, pain management and surgery centers
- Therapy practices: physical therapy, chiropractic and acupuncture
- Imaging and diagnostics: MRI, radiology and diagnostic testing
- Pharmacies and DME suppliers: pharmacies and medical equipment and supply companies
What we do
Arbitration of denied claims
We file denied no-fault claims in arbitration and argue them, prepared with data on the arbitrator and the insurer: the same New York no-fault arbitration awards that our Arbitrator Scorecard and Provider Report are built from.
Court collections and appeals
We bring actions in Civil Court on denied claims and handle the appeals.
Billing support
We bill and submit claims through our in-house software, with procedures built on analysis of past collection outcomes.
Examinations under oath
We represent providers at the examinations under oath (EUOs) that insurers request.
RICO and fraud litigation
We defend providers in the civil RICO and fraud actions that insurers bring against them.
Common questions
General information, not legal advice about a particular claim.
How long does an insurer have to pay or deny a no-fault claim?
Thirty calendar days after it receives proof of the claim. Proof of claim includes any additional verification the insurer properly requested, so a timely verification request extends the time until the verification arrives (11 NYCRR 65-3.8 [a] [1], [c]). A claim that is neither paid nor denied in that time is overdue. More on verification requests.
What interest does an overdue claim earn?
Two percent per month, calculated pro rata on a 30-day month (11 NYCRR 65-3.9 [a]). After a denial, timing matters: if the provider does not request arbitration or start a lawsuit within 30 days after receiving the denial, interest stops accumulating on the disputed claim until it does (65-3.9 [c]).
What does a provider have to show to win a no-fault claim in court?
On a motion for summary judgment, that it mailed the claim on the statutory billing form, that the insurer received it and that payment is overdue, with the mailing proved by admissible evidence. The provider does not have to prove the medical merits of the claim, as the Court of Appeals held in Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015). More on the provider’s prima facie case.
How long does a provider have to bring a claim?
It depends on who pays. Against an insurer that issued the policy, six years (CPLR 213 [2]), as Appellate Division decisions uniformly hold. Against a self-insurer, three years (CPLR 214 [2]), as the Court of Appeals held in 2018 in Contact Chiropractic, P.C. v New York City Tr. Auth. Against MVAIC, three years, as both Appellate Terms have held. More on which limitations period applies.
What must an insurer prove to deny a claim because a scheduled EUO or IME was missed?
That it timely and properly requested at least two examinations, that it mailed the scheduling letters and that the person did not appear, shown by someone with personal knowledge; the Appellate Division applies these elements in both the First and Second Departments. Whether the insurer must also have denied the claim on time on that ground is where the courts split: the First Department says it need not, the Second and Fourth Departments say it must. More on proving a no-show and on whether the defense needs a timely denial.
Research we publish
- No-Fault Search: our database of about 5,800 New York no-fault decisions and the text of 11 NYCRR Part 65, searched by words, citation or a plain-language question
- Legal Questions: the leading authorities and every decision in the database on 14 recurring questions, with how each court and department has ruled
- No-Fault Regulations: Part 65 section by section, with the decisions that cite each provision
- New Decisions: the latest decisions, month by month
- Arbitration data: the Arbitrator Scorecard, the Provider Report and more, built from New York no-fault arbitration awards and updated every month
Contact
Beynenson Law
P.O. Box 5006, East Hampton, NY 11937
Phone: 347-746-6001
Fax: 347-803-1803
Email: contact@beynensonlaw.com
Or send us a message through our contact form.