No Fault Arbitration Lawyer in Queens, NY

Yes. Additional personal injury protection benefits that are both mandatory and overdue bear interest at a rate of two percent (2%) per month, calculated on a pro-rata basis using a 30-day month. An insurer must deny or fail to pay a claim within the mandatory 30-day period. If the insurer does not act in one of those two ways, the claim begins to accrue interest at that point, as it has become overdue. If arbitration or a lawsuit is not commenced within 30 days of the receipt of the denial of claim form for payment of benefits, the accrual of interest is paused until an action is begun.

For cases valued at less than $2,000, the arbitrator may decide the case based solely on written submissions. Otherwise, the hearing will likely be over a video conference. Hearings frequently last several hours, depending on the number of witnesses and the amount and complexity of the evidence in the case.

At an arbitration hearing, both parties can present opening statements to the arbitrator. After opening statements, each side will have the opportunity to present evidence and call witnesses to testify. The opposing party can also cross-examine the other side’s witnesses. The medical provider typically presents their case first, followed by the insurance company. At the end of the hearing, both parties can present closing arguments to summarize the evidence and explain why it supports their claim.

The arbitrator may close the record at the end of the hearing, meaning that neither party can submit additional evidence, or leave the record open if they need to request more documents or information from either party. However, once the arbitrator closes the record, they will usually submit their decision to the parties within 30 days.

When you request no-fault arbitration in New York, you will need to submit various documents to the American Arbitration Association (AAA), which administers New York no-fault arbitrations.

First, you must submit the completed second and third pages of the NF-10 Denial of Claim Form that you received from the insurance company. Alternatively, you can submit a completed AR-1 Form – Request for New York No-Fault Arbitration. The AAA will not accept any submitted forms with missing information.

You must also submit all documentation supporting your claim that you want the arbitrator to review, such as:

• Assignment of Benefits Form signed by the patient
• All NF-3 forms or bills in dispute
• Medical records
• NF-10 form indicating the reason for denial
• Proof you submitted your claims in time
• Any verification responses and rebuttals
• Any relevant case law or prior arbitration awards

If you file a request for no-fault arbitration after the deadline, the insurance company may ask the arbitrator to dismiss your request as untimely. As a result, you may lose the opportunity to obtain compensation owed to you under the no-fault insurance system.

It’s crucial to contact a no-fault arbitration attorney as soon as you receive a denial or when the insurer’s response is overdue. They can start preserving evidence and building your case in time to meet any deadlines.

You typically have six years after an insurance company denies a reimbursement claim under a PIP policy to submit a formal request for no-fault arbitration. While there are exceptions, you shouldn’t wait too long to request no-fault arbitration.

You must submit substantial documentation to support your request, which will take time to secure and organize. The sooner you contact our attorneys, the sooner we can get to work preparing your case.

An insurer may deny a medical provider’s no-fault insurance claim for various reasons. Some of the most common grounds for a denial include:

• Late billing submission
• Insufficient evidence to prove treatment was reasonable and necessary
• Insufficient evidence linking injuries to the car accident
• Insufficient records supporting billed services
• Late or no response to verification requests
• Improper billing codes
• Lack of applicable insurance coverage
• Lack of a valid assignment of benefits
• Exhaustion of PIP coverage

If the insurance company denies your no-fault claim, you can appeal the decision and go through the arbitration process. Our experienced attorneys can help build a no-fault arbitration case that defends against the insurer’s tactics and protects your right to compensation.

Although the law doesn’t require you to have legal representation, hiring a no-fault arbitration lawyer to advocate for you can take the burden off your shoulders and protect your claim. Some crucial ways our team can help include:

• Navigating the arbitration process – No-fault arbitration proceedings involve complex rules and procedures. A lawyer has more experience handling these cases and can walk you through the process.
• Understanding the system – An attorney will have in-depth knowledge of car accident laws and PIP/no-fault insurance rules that they can use to support your case.
• Defending against insurer tactics – A no-fault arbitration lawyer will have more experience with the types of legal tactics and arguments that insurers use in arbitration proceedings, which can help them develop an effective legal strategy.
• Pursuing a favorable outcome – Arbitrations result in binding rulings with limited rights to appeal, which increases the stakes. An attorney can help you present a compelling case seeking the compensation you are owed.

New York’s no-fault insurance system can be challenging to navigate for those who do not fully understand it. Insurance companies know this and will use it to their advantage.

Don’t try to stand up to a major insurance company alone. Our dedicated attorneys have extensive experience with the claims process and can help you manage every step. Whether it’s preparing your claim, negotiating a settlement, or representing you at an arbitration hearing, we are ready to put our legal knowledge and skills to work for you.

Contact the patient/patient’s legal representative or contact the Workers Compensation District office. The New York Workers’ Compensation telephone directory can be found here. Copies of all documentation should also be sent to the NYS Workers’ Compensation Board either via mail to P.O. Box 5205, Binghamton, NY 13902, OR via fax to 1-877-533-0337. Complex legal issues can arise at the intersection of workers’ compensation law and no-fault insurance policies. To learn more about your specific issues, contact The Tadchiev Law Firm, P.C., today.

If you fail to provide a proper legal answer to the Declaratory Judgment motion, a Default Judgment may be granted against you. It is crucial that you hire a law firm with the experience to provide you with proper legal representation.

The Health Insurance Portability and Accountability Act (HIPAA) provides data privacy and safeguards for medical information. HIPAA applies to all healthcare providers that transmit health information in electronic form. The mandate protects individuals’ health information from being used or disclosed by covered entities. Covered entities are any organizations or corporations that directly handle protected health information.

Protected health information under HIPAA includes:

• The patient’s name, address, birth date, and Social Security number.
• An individual’s physical or mental health condition.
• Any care provided to an individual.
• Payment information that identifies the patient or could be used to identify the patient.

New York no-fault law mandates that every person injured in a motor vehicle accident receive payment for medical costs, lost earnings and other reasonable expenses. This “personal injury protection” (or PIP) is informally known as “no-fault” because the insurance company is required to provide coverage regardless of who was at fault for the accident. Accident injury victims are eligible to receive no-fault benefits if:

1. They were injured in an automobile accident;
2. They were a pedestrian, bicyclist or snowmobile rider struck by an automobile, motorcycle or ATV; or
3. They were hurt during the use, operation or maintenance of a motor vehicle.

All providers and hospitals covered by the Health Insurance Portability and Accountability Act (HIPAA) are now required to use the new International Classification of Diseases, 10th Edition (ICD-10), which is a diagnosis and procedure coding system. Current Procedural Terminology (CPT) codes, which are usually used when claims for health care services are reported to workers’ compensation and no-fault insurers, are not affected by ICD-10. The New York Workers’ Compensation Board made the change to ICD-10 in order to be consistent with both Medicare and Medicaid, and to avoid the costs of supporting two diagnostic coding systems.

Providers can sometimes receive payment for no-fault claims even if the injured person’s policy has already been exhausted. In order to determine whether you may be able to receive payment for those kinds of claims, contact us so we can evaluate the validity of the insurer’s denial.

The breach of policy relieves the insurer of the obligation to provide coverage for all future claims for the injured party’s health services arising from the same accident. Pending claims submitted by the carrier may also be denied based on the policy breach.

However, if the pending claim is for treatment provided prior to the policy breach, an arbitrator or court of law may find the denial ineffective. An insurer’s successful denial of claims due to policy violation does not create a right of recovery for the insurer for benefits previously paid.

Yes, a medical provider may receive payment for no-fault claims provided to injured parties who violated the insurance policy by failing to appear for two IMEs or two EUOs. An insurance carrier must meet numerous legal requirements to successfully deny a no-fault claim based on the injured person’s failures to appear for IMEs or EUOs.

A medical lien is a claim for repayment that is placed against an accident victim’s personal injury case. Essentially, a medical lien gives a medical provider the right to be repaid for its services from any settlement, judgment or verdict awarded in a personal injury lawsuit to the accident victim. The lien is created by a form authorizing the medical provider to place a lien in the event the insurance company denies the provider’s no-fault claims for the patient. The denial may be due to:

• Lack of coverage for reasons such as fraud or material misrepresentation;
• A policy violation, such as a failure to appear for two IMEs; or
• The exhaustion of the policy’s benefits.

The AOB form should not be modified. Added language that would attempt to make the patient responsible to pay for medical services will be given no legal effect. For example, it is prohibited to include language in the AOB stating “in the event that the no-fault carrier fails or refuses to pay for the services provided then I, the patient, agree that I will be responsible for the value of the services rendered by said Doctor.”

Generally, a physician who accepts a no-fault assignment of benefits from a no-fault patient may not pursue the patient directly for payment. The form for no-fault assignment of benefits is considered a legal contract. Under that contract, the physician assumes the legal rights to no-fault benefits held by the injured party.

The insurance company can successfully deny the claim for a few reasons, including the lack of insurance coverage because of fraud by the patient, or a policy violation, such as the patient’s failure to appear at independent medical evaluations (IMEs). In those instances, payment could be sought from the patient. The physician can also pursue payments from the patient when payments from the no-fault policy are exhausted.

Before treating an injured individual, healthcare providers that accept no-fault insurance as a form of payment should ensure the injured individual provided “notice of claim” to the appropriate insurance company. The person would have provided the notice by filing one of these documents within 30 days after the accident:

1. an NF-2 form;
2. an NF-5 form; or
3. a Department of Motor Vehicles Accident Report 104 (MV 104) indicating injury.

The minimum amount of no-fault benefits available to individuals injured in New York motor vehicle accidents is $50,000 for medical expenses, lost earnings and other reasonable expenses. Any individual can purchase APIP (Additional Personal Injury Protection) to increase the no-fault coverage by another $50,000.

Any individual can purchase OBEL (Optional Basic Economic Loss) coverage of up to $25,000 that extends no-fault coverage beyond the minimum $50,000, for a total of $75,000. Through OBEL the injured individual gets to decide which expenses are covered. For example, an injured party can choose to have the additional $25,000 coverage go towards lost wages. Note that OBEL coverage can only be utilized after the injured person has exhausted the initial $50,000 of basic economic loss coverage.