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Being a healthcare provider working with car accident victims under a No-Fault law in New York requires faith in the insurance process, and faith you will ultimately receive fair compensation for the medical treatments you provide to a victim. Unfortunately, attempting to recover No-Fault insurance benefits for unpaid medical bills can be a struggle — especially when you must focus on providing your patients with top-quality care.
At The Sigalov Firm PLLC, we understand our clients do not have the time, legal understanding, or patience to pursue insurers for payments.
We are proud to offer our No-Fault collections services to doctors and healthcare providers attempting to recover payments for medical bills. When a claim is submitted, there is a continuous struggle with delayed or denied claims, extended claims investigations, and a variety of other pitfalls that can leave an unpaid claim pending in the administrative process of No-Fault insurance claims.
Read more below to have a better sense of the support No-Fault collections attorneys at The Sigalov Firm can provide. Contact us as soon as possible to request a free consultation about your case.
One of the insurance industry’s preferred actions when denying No-Fault claims is to deny a claim for a lack of medical necessity. In some instances, this is a completely legitimate denial, but is also one of many ways insurers abuse the system to avoid paying full and fair compensation to a No-Fault medical provider.
To legitimize this type of denial, an insurer will provide a peer review from a doctor, who is presumed to be an unbiased third party reviewing the facts and determining whether or not the care was legitimate and necessary. Unfortunately, No-Fault insurance providers have been known to use doctors that rule overwhelmingly in favor of the insurer. These doctors can often benefit financially by siding with the insurers.
When you partner with the Sigalov Firm, LLC, you can be confident there is a dedicated attorney fighting to analyze the entire claim, review any denials or deferrals, and hold the insurers accountable to their obligations when handling a No-Fault claim.
We will review the peer reviewer’s report and expose issues such as:
These are just a few of the many approaches we have years of experience using. The compensation we have recovered for our healthcare provider clients demonstrates the importance of experience when handling No-Fault claims.
Another tactic the insurance companies will use to avoid paying is by leveraging the Independent Medical Examinations (IME) they often require for injured victims. Just as with a peer review carried out by a doctor who is being paid by the insurance carrier, IME doctors earn significant compensation from the insurance provider for handling these exams.
These exams are very quick, with most taking between 5-10 minutes, and the IME doctor often determines the injured party has a full range of motion, no disability, and no need for additional care. When the IME report states the victim is in good health, the insurance provider has additional support in their denial of a claim.
Working with an experienced legal professional is one of the best ways to remain focused on providing care to your patients, without being bogged down by pursuing an insurer for the money you have rightfully earned through the care you have provided. We will review the IME report and criticize issues like positive findings that should factor into the doctor's conclusion, as well as any symptoms or injuries ignored during the process.
The Sigalov Firm has years of experience successfully representing claims that are denied or delayed by the insurance carrier due to inaccurate medical necessity reports or other stalling tactics. We understand the importance of being paid for the medical care you have provided, and will work tirelessly on your behalf to ensure you receive every last dime you are entitled to.
Founded in 2009, The Sigalov Firm is a close-knit boutique firm based in Mineola, Long Island, NY. We provide fierce representation and build strong relationships with our clients. Our commitment is to complete client satisfaction and that is the driving force behind our firm.
Our firm focuses on No-Fault collections. That includes No-Fault arbitration, No-Fault litigation, and healthcare law as it relates to No-Fault.
No-Fault is a niche area of the law and few firms focus on it exclusively. We’ve been focused on No-Fault law since 2009 and we believe that this sole focus makes us better prepared to handle your cases. Clients often choose us because we don’t typically charge a recovery fee; that is, the healthcare provider keeps the entire principal and interest payment recovered from the insurer.
Healthcare providers that have provided services to people injured in car accidents but have not been paid are entitled to have their claim resolved in binding arbitration. Arbitration is similar to litigation but with relaxed rules of evidence and is typically faster than litigation.
Sophisticated healthcare providers typically choose arbitration over litigation because it's speedier. Speed is important not only because it hastens your payment but also because it maximizes your chances of recovery prior to policy exhaustion and sometimes prior to a DJ action. However, arbitration is occasionally suboptimal when the strict rules of evidence in court favor healthcare providers.
Healthcare claims are most commonly denied for an alleged “lack of medical necessity.” Other common denial reasons are alleged fraud, failure to show for an EUO/IME, failure to timely answer verification requests, failure to submit your claim on time and fee schedule disputes.
No-Fault arbitrations go through a mandatory conciliation process and may be resolved through settlement as quickly as three weeks from the date of filing. However, if the arbitration is calendared for a hearing, it may take as long as a year to resolve the claim.
No, we cover the per arbitration filing fee, which is returned to us once we prevail. Additionally, insurance carriers pay us an attorney fee once we prevail.
Once you choose a forum where to dispute a particular case you’re not entitled to file the same case in another forum, unless that case has been discontinued without prejudice.
Most healthcare providers are shocked to learn that an IME can be as short as just 45 seconds. It almost seems as though the IME process is designed for the sole purpose of denying your patient their benefits. The ultimate decision on whether to continue to provide healthcare services to an injured person should be based on applicable medical standards of care. If you believe that the injured requires additional services and you’re denied payment, we’re prepared to help you recover any payments.
Absolutely. And you may do so via Zoom from the convenience of your home or office. We find that healthcare providers make great witnesses when advocating for the necessity of their services.
Yes. Ignoring a verification request, no matter how repetitive or obtuse, may lead to a denial that is upheld in arbitration or litigation. Therefore, it’s vital that all verification requests be answered, even if only to notify the insurer that they are not entitled to the information they seek or to object on some other grounds.