Orthopedics No-Fault Collections Attorney in NY

The doctor shows an x-ray scan to the patient

A car accident can be life-shattering for an accident victim and an orthopedic surgeon plays a vital role in putting the pieces back together again. Surgeons are essential in the medical treatment and recovery of motor vehicle accident victims. Yet, insurance carriers too often delay or deny orthopedic claims, which results in unpaid No-Fault medical bills.

Insurance carriers’ have honed techniques and practices that stymie reimbursement for Orthopedic No-Fault claims. At The Sigalov Firm PLLC, we are proud to offer our No-Fault collections services to Orthopedic surgeons and healthcare providers that seek to recover payments for medical bills. We understand that medical providers and their offices do not have the time or the legal knowledge to vigorously pursue each No-Fault claim, nor should they have to. We are knowledgeable in the underlying medical diagnoses of joint and spinal surgeries and treatment and can help you advance your claims accordingly. 

No-Fault Collections for Doctors and Medical Providers

The No-Fault law was created to ensure that victims of motor vehicle accidents have access to medical care regardless of who was at fault. The NY No-Fault fee schedule describes the amount insurance companies are obligated to pay for various medical procedures. However well-intentioned this law is, people injured in motor vehicle accidents receiving top medical care and medical providers being reimbursed are often at odds. 

Despite the No-Fault law’s intention that medical treatment should be speedy, orthopedic surgeons are often denied payments for their services for a variety of reasons you may already be familiar with; an alleged lack of medical necessity or an alleged insurance policy condition violation. 

Our team at The Sigalov Firm PLLC has the legal knowledge necessary to review and analyze your claims. Working with us will help ensure that you’re properly compensated for your services. 

Understanding New York No-Fault Collections and No-Fault Denials

Insurance carriers stay profitable and in business by maintaining a strong focus on limiting their liabilities. Though a great many people working at insurers are fine, honest individuals, the system’s incentives drive carriers to maximize claim denials. 

A legitimate and necessary claim can be denied for a variety of reasons, the most common of which include what follows below… 

Peer-Reviewed Denial 

A peer-review denial is a type of medical necessity denial. It is based on a written opinion by an expert that was hired by the insurer to review an injured person’s medical records and determine which healthcare treatments were necessary and which were not. No-Fault insurance companies have been known to use doctors that decide overwhelmingly in their favor. 

These types of denials may be rebutted in several ways. The treating physician may offer a written rebuttal, testimony rebutting the peer review, or, alternatively, the peer-review denial may be rebutted with a third-party doctor’s testimony or written opinion. 

We have several additional approaches that we have developed over the years to defeat peer-review-based denials. These include researching peer reviewers and, where appropriate, highlighting their history of malpractice, inadequate credentials, lack of medical literature to support their claim, factual inaccuracies, logical errors, and failure to admit positive findings or articulate the relevant medical standard of care. 

When you partner with The Sigalov Firm PLLC, you can be sure that our law firm will take an aggressive and firm stance against any bad faith practice. We have a detail-oriented process to review claims and develop strategies to help you maximize recovery. 

IME-Based Denials

While a peer review is done simply by reading the medical charts and background on a patient’s case, an Independent Medical Examination (IME) is done in person. This is a medical examination that is supposed to determine whether a person involved in a car accident has injuries stemming from that accident which entitle them to continue to receive medical treatment under a No-Fault policy. The incentives for an IME doctor are similar to those for a peer-review doctor — doctors know that the more insurer friendly their opinions are, the more likely they are to be hired on a repeat basis. In our experience, the IME doctor usually concludes that the injured person has fully recovered and therefore no longer needs additional treatment. It’s a convenient conclusion for the insurance carrier, but not for the patient or you.

Why You Should Choose The Sigalov Firm PLLC

Collecting unpaid No-Fault bills is both nuanced and laborious. It is not something to attempt on your own. Working with an expert No-Fault collection lawyer will help you to maximize recovery on your outstanding bills. Our knowledge of No-Fault disputes and medical treatment ensures that our clients have the best representation when collecting their unpaid expenses. 

Contact us today at (347) 489-7830 and request a free consultation. We will then carefully review your outstanding claims, analyze their merits, and quickly initiate arbitration. We look in-depth at the specifics of your case and determine the optimal action for your unique situation.

Two people shaking their hands


Will a No-Fault Claim Denial Lead to Arbitration?

In many cases, denials are unjustified and based on technicalities or errors. If this happens to you, you have the right to file for arbitration. Arbitration is a type of dispute resolution in which an impartial third party, the arbitrator, hears both sides of the dispute and makes a decision. The arbitrator’s decision is binding, which means the insurance company will be required to pay the claim if the arbitrator rules in your favor.

What Is an IME No-Show?

IME no-shows are a common problem for No-Fault providers because insurers will often request an IME at some time during an injured person’s course of treatment. The insurance carrier has the right to request that an eligible person attend a medical appointment with an independent doctor. This appointment is necessary for the progress of the claim. If the injured person misses two such appointments, the insurer may rightfully deny the claim based on the failure to attend.

What Is EOU?

As with an IME, the insurance carrier has a contractual right to request an Examination Under Oath (EUO).  The carrier may request a EUO from the injured person or from a treating doctor’s medical office. And we see that commonly an insurer will request EUOs from both the injured person and the treading doctor’s office. 

The EUO is a formal proceeding that typically takes place in a law office or the office of a court reporting agency. Unfortunately, a EUO is typically an adversarial proceeding where the insurer’s attorneys seek to uncover facts that would help them disqualify a claim, or perhaps to even disqualify all the claims of a healthcare provider based on a theory of fraudulent incorporation. We believe it’s important that you have competent EUO counsel to represent you during a EUO proceeding.