New York No-Fault attorneys for healthcare providers Denied?
Delayed? Get paid for the care you provided.
We can recover your money in as little as four weeks, and we advance arbitration filing fees and litigation costs.
New York Motor Vehicle No-Fault Insurance Law
Denial of claim
- Insurer
- Claim number
- Injured person
- Provider
- Your practice
- Amount of claim
- Date of denial
Reason for denial
- Not medically necessary, based on a peer review
- Failure to appear for an IME or EUO
- Fees not in accordance with the fee schedule
- Bill not submitted within 45 days
Peer review ignores
the positive findings.
Was this denial
issued on time?
Founded in 2009. More than 60,000 cases resolved before the American Arbitration Association under
Gene Sigalov’s management.
Which denial did you get?
Find the reason as the insurer worded it on your denial. Each page explains that denial and how it can be answered.
- Treatment not medically necessary Medical Necessity Denials that rest on a paid peer reviewer’s opinion. Our strength is discrediting the peer reviewer’s medical report.
- Denied based on a peer review Peer Review Denials Insurers use an outside review of the patient’s records to deny payment for care you provided.
- Benefits terminated after an IME IME Cut-off Denials When the insurer’s IME doctor calls the injuries resolved, we look for omissions, an inadequate exam, and contradicting records.
- Failure to appear for an IME IME No-show Two missed IMEs can cut off benefits back to the accident date. The carrier must prove the requests were properly mailed.
- Failure to appear for an EUO Examination Under Oath What an EUO is, how to prepare for one, and what happens after it, for injured people and for providers.
- Bill not submitted within 45 days 45 Day Rule Bills generally must be submitted within 45 days of service. Providers who complied can still get a late-billing denial.
- Fees not in accordance with the fee schedule Fee Schedule Carriers often pay part of a bill and deny the rest as “fees not in accordance with fee schedules.”
- Claim denied No-Fault Claim Denial Insurers use procedural barriers to deny valid claims. We highlight the weak points of each denial in arbitration or litigation.
We represent healthcare providers such as pharmacies, doctors, surgeons, chiropractors, acupuncturists, physical therapists, and medical supplies providers.
Collections for MRI Facilities, Surgeons, Medical Supply Companies, Hospitals, Article 28 Facilities, Orthopedics.
How we recover No-Fault Arbitration, No-Fault Collection Attorneys, Healthcare Consulting.
What happens when you send us a bill
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You send the bills
Send the denied or unpaid bills with the papers listed here. We accept paper file records and provide free digital access to all records that have been scanned.
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We review them, free, and file
Free no-obligation review of your bills and our professional assessment. We advance arbitration filing fees and litigation costs.
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Conciliation, then a decision
Conciliation can settle a filed arbitration in as little as three weeks. A case calendared for a hearing may take as long as a year. You may testify by Zoom from your office.
What to send
- Client form A completed Client Information form (for new clients only).
- Assignment of benefits Assignment of benefits signed by the injured party.
- Bills Bill(s) for unpaid treatments, services or supplies.
- Proof of mailing Proof of mailing for the bill(s).
- Proof of answers Carrier verification requests and your answers, if any. Proof of answers, such as fax receipts, are also important.
- Patient’s FULL medical file There is no such thing as too much information.
Do I have to pay anything?
- Arbitration filing fee
- We cover it. It is returned to us once we prevail.
- Attorney fee
- Insurance carriers pay it once we prevail.
- Recovery fee
- We don’t charge one. The healthcare provider keeps the entire principal and interest payment recovered from the insurer.
Case results
Decisions in No-Fault disputes we handled. Each one opens the decision itself.
Prior results do not guarantee a similar outcome.
The people who handle your claims
We are one of the few select firms in the greater NYC area that focuses solely on No-Fault law for healthcare providers.
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Gene Sigalov
Attorney
Founder. More than 60,000 cases resolved before the American Arbitration Association under his management. J.D., Benjamin N. Cardozo School of Law.
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Jeffrey Datikashvili
Attorney
Litigation and No-Fault arbitration in New York. Began his career interning for Justice Martin E. Ritholtz, Supreme Court, Queens County. J.D., Hofstra.
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David Yalkut
Paralegal
More than 19 years in No-Fault collections, with working relationships with AAA conciliators, defense firm attorneys and carrier adjusters.
Request a free bill review
Use this form or call to start. Tell us about the denied or unpaid bills, and we will reply about how to send them and the records. The review is free.
- Phone
- (347) 637-8933
- info@sigalovfirm.com
- Business hours
- Mon-Sun 9 AM - 7 PM
- Office
- 1225 Franklin Avenue, Suite 500Garden City, NY 11530
No-Fault attorney FAQs
Have a question that is not here? Call (347) 637-8933, Mon-Sun 9 AM - 7 PM.
Who are we?
Founded in 2009, The Sigalov Firm is a close-knit boutique firm based in Garden City, 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.
What areas do we practice in?
Our firm focuses on No-Fault collections. That includes No-Fault arbitration, No-Fault litigation, and healthcare law as it relates to No-Fault.
Why hire our firm?
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.
What are No-Fault arbitrations?
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.
Is arbitration always better 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.
Why would an insurance company deny my claim?
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.
How long does it take to resolve a filed arbitration dispute?
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.
Do I have to pay anything?
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. If we do not prevail, you owe us nothing.
Can I file litigation and then switch to arbitration or vice-versa?
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.
What should I do if my patients’ benefits were cut-off based on a negative IME?
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.
May I testify at my arbitration hearing to prove that the medical procedure was medically necessary?
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.
Do I need to answer verification requests?
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.