No-Fault Claim Denial Lawyer in NY
The process of going back and forth with an insurance company after they deny a No-Fault claim for care that you have already provided is a frustrating experience for many healthcare providers. At its core, our state’s No-Fault insurance program is designed to streamline the entire care process after an accident, guaranteeing speedy treatment to those injured in motor vehicle accidents. Access to care is based on healthcare providers’ confidence that they’ll be reimbursed for their services without delay.
The unfortunate truth with New York’s No-Fault insurance system is that insurance companies have spent the last few decades developing ways to avoid paying for the bills sent to them by healthcare providers. There are procedural barriers to deny payment for perfectly valid claims that they can, and often do, take advantage of.
Common Reasons For No-Fault Claim Denials
Insurance companies are for-profit corporations. They make money by limiting their claim payments. There are several reasons that insurance companies may deny a No-Fault claim. A few of the most common reasons include the following:
The Treatment Is Not “Medically Necessary”
Most commonly, the insurance company will argue that the treatment is not “medically necessary” — even if you as the treating physician have determined that the treatment is necessary to improve the patient’s condition. The insurance company will hire a peer-review doctor who will review the patient file and write a report that references the patient’s medical records and medical studies in support of their reasoning for why the services you provided were not necessary or did not follow the standard of care. He or she may fail to properly cite these papers or adequately link the evidence provided in the paper with their findings. If this is the case with your denial, we will make these arguments in arbitration or litigation to highlight the weak aspects of their denial.
The IME Doctor May Claim That the Victim’s Injuries Are Healed
In other cases, an IME doctor may conclude that the victim’s injuries have resolved and that further treatment is unnecessary. This is frequently contrary to the opinion of the treating physician, and we can use this discrepancy to our advantage in the arbitration or litigation process.
When a patient does not show up for two IME in a row, the insurance company will use this as a basis for denial. In some cases, an insurance company may schedule an IME but then cancel or reschedule the appointment at the last minute. This is a tricky tactic, but not one we haven’t seen before.
Intimidation During an Examination Under Oath
An insurer is entitled to demand that the injured person sit for an Examination Under Oath (EUO) about their accident, injuries, medical treatment, and ongoing condition. Insurers may also require a healthcare provider to submit to a EUO.
A provider questioned at an EUO should typically be asked about the standard of care, why the provider administered certain types of care, and other healthcare-specific questions, but these examinations often veer into questions of ownership, billing practices, and marketing practices — what lawyers refer to asl a fishing expedition.
The Importance of Working With Legal Representation After a No-Fault Claim Denial
Just as the insurers intend it, the process of litigating a denial and pursuing the compensation you’re entitled to under your No-Fault policy is tedious and complicated. You have enough work without having to worry about the claim recovery process. That is why it’s so important to have an experienced New York No-Fault Attorney on your side who can handle the insurance companies for you.
This is not something to handle on your own. At the Sigalov Firm, we know how to deal with insurance companies and will do everything in our power to ensure you get the full compensation you deserve.
Contact The Sigalov Firm For a Free Consultation About Your No-Fault Claim Denial Today
At The Sigalov Firm PLLC, our team of experienced No-Fault insurance denial lawyers has been helping New York healthcare providers fight back against insurance companies for years. We know the tactics that insurance companies use to try and deny valid claims, and we will put our experience to work for you to get the compensation you deserve.
The first step to reimbursement on a No-Fault claim denial is to contact an experienced attorney who can evaluate your case and help you determine the best course of action. You can do so directly through our website. At the Sigalov Firm, we have helped many healthcare providers get the compensation they deserve after their claims were wrongfully denied, and we’re ready to put our experience to work for you. We’re here to help you get the compensation you need and deserve.