In 2016, our No-Fault Practice Team saved our clients nearly $4 Million, by utilizing a proactive, cost effective and successful approach to handling and defending no-fault actions, filed in the various Courts and Arbitration forums in the State of New York. Our team is proficient in not only defending the matters based upon the obvious reasons identified on the face of the relevant documents, but has a keen eye for dissecting each and every assigned claim to ensure it has been accurately submitted and is in compliance with the applicable statutes, regulations and laws of each jurisdiction. This detailed approach provides our client with the ability to defend claims that have been improperly submitted, do not comply with the rules, regulations and statutes, are overinflated or are not subject to coverage.

 

Congratulations to David J. Tetlak  and our No-Fault Practice Area in prevailing in an Arbitration matter involving the issues of billing in accordance with the applicable fee schedules and compliance with the 45-day rule regulation. Applicant, an orthopedic facility, sought in excess of $80,000, for services allegedly rendered. After Respondent presented its evidence regarding proper reimbursement, pursuant to the applicable fee schedule, Applicant amended the amount sought to just under $50,000. Respondent insists that it did not receive a bill prior to 4/17/15 and Applicant maintains that the bill was submitted by mail on 3/2/15. Respondent's ECF contains a bill dated 4/17/15 that contains two stamps to the effect that the bill is "original" and "not a duplicate". Respondent's claims examiner submitted an affidavit attesting to his not having received the bill in issue prior to 4/17/15.  Respondent's Attorney asserted that Applicant's AR1 indicates that the bill was mailed on 2/5/15. However, the proof of mailing described in the billing manager's affidavit reflects mailing on 3/2/15.  Furthermore, the ECF contained a heavily redacted log sheet that bears a US Postal Service post mark of 3/2/15. We argued that these overly extensive redactions render the log virtually useless in establishing mailing on 3/2/15. The Arbitrator agreed, sustained the Respondent's positions and held that the Applicant failed to comply with the regulations regarding timely submission of the claim.

 

Congratulations to Mark Zemcik and our No-Fault Practice Area in prevailing in an Arbitration matter involving Applicant's failure to respond to Respondent's request for verification. Applicant sought reimbursement in excess of $9,800, for medical service allegedly provided to the Assignor.  Respondent asserted that there remained outstanding verification.  Applicant contended that it responded to Respondent's request and presented two proofs of mailing.  Respondent's counsel argued that it never received Applicant's letter.  Furthermore, the proof of mailing reflects that the response was sent by certified mail on March 15, 2014, three months prior to the date on the letter purported to be contained therein.  Therefore, the Arbitrator sustained Respondent's position that the response was never mailed by Applicant and never received by Respondent, as required by the applicable regulations.     

 

Congratulations to Mark Zemcik and our No-Fault Practice Area in prevailing in an Arbitration matter involving in excess of $93,000, due to the Applicant's lack of standing and failure to make a prima facie case.  Respondent argued that the Applicant did not submit a statutory no-fault claim, or a functional equivalent, did not upload an assignment of benefits form in its favor, uploaded an incorrect assignment of benefits, the services were provided at an accredited surgery center in New Jersey while the codes used are not allowed for an ASC according to the New Jersey Fee Schedule and other bills reflect the patient underwent surgery in New York, on the same day. Applicant withdrew this matter, after two hearings. 

 

Congratulations to Peter Caso and our No-Fault Practice Area in prevailing in an Arbitration matter involving nearly $10,000, due to a lack of medical necessity and lack of causation to the subject accident.  Respondent asserted, through competent medical evidence, that the subject medical services were for injuries unrelated to the accident. Respondent argued that the IME doctors clearly indicated that the injury was not related to the motor vehicle accident. Applicant has  failed to establish that the injuries were causally related to the motor vehicle accident. Furthermore, Applicant has also failed to establish that the treatment was medically necessary. Accordingly, Applicant's claim was denied, by the Arbitrator, with respect to this claim.

 

Congratulations to Albert Galatan and our UM/SUM Practice Area in prevailing in a case where the Respondent was struck by a car with diplomatic plates. The Respondent, having done no investigation, immediately filed for uninsured motorist benefits. Under international law, and several Geneva conventions, diplomatic plates can only be issued through the State Department and insurance is a compulsory requirement. After doing the research on the possible places, to determine who insured the vehicle in question, it was learned that there is a specific broker (Pharos Insurance brokers) handles almost all of the diplomatic insurance, which led to a specific carrier that also insures most of the diplomatic corps. However, in order to match the plate with a country, we had to contact the United States Department of State. We were able to ascertain that the car was insured through a valid insurance policy and owned by the Office of Cultural Services of France. Consequently, we were able to secure a speedy resolution for our client, without the necessity of a Framed Issue Hearing, as France recognized involvement and that their vehicle was covered. Thus, within four months of receiving the file, we were able to successfully and favorably resolve the issue for our client.