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Auto Accidents - Getting Paid
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Our No-Fault Department specializes in the billing and collection of claims generated by the treatment of patients involved in motor vehicle accidents. Our systems and procedures were developed by attorneys specializing in No-Fault collections and are designed to facilitate all the necessary components to file and collect on claims in a quick and efficient manner in accordance with the N.Y. State No-Fault Regulations.
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Treating patients and getting paid by the No-Fault system can be an exercise in futility. When your claims are denied, your options are limited. Having representation by people who are experts in dealing with the No-Fault system is paramount in getting fair compensation for the services provided.
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Your options for obtaining payment include:
  1. Lien against a bodily injury suit.
    1. instead of submitting a claim under no-fault, the patient signs an agreement that if and when a monetary award is received the provider's bill will be paid.
    2. It may take years for the suit to move through the court system.
    3. Recovery is not guaranteed and you lose the right to submit a traditional claim.
    4. In the event that money is awarded, it may not cover the outstanding medical bills.
    5. Customarily, once money is awarded, the amount paid toward the medical bills is negotiated down.
  2. AAA Arbitration
    1. After submitting your bills to the No-Fault carrier and getting a denial of payment, you may submit the denied bills to binding arbitration.
    2. The requirement for instituting the arbitration process include:
      1. A $40 filing fee
      2. A complete set of medical records and bills
      3. A detailed letter of medical necessity for each treatment rendered
    3. The insurance company pays approximately $300 for this process which is their only cost. A medical expert is not required.
    4. The insurance company provides to the arbitrator a copy of the documents on which their denial is based. This may include the insurance peer review and any independent medical examination reports(IME).
    5. The arbitrator bases his decision upon the records submitted.
    6. The arbitrators are not bound by case law, decisions by other arbitrators in similar cases and they have no medical expertise.
    7. In using the arbitration system for no-fault recovery, the recovery dollars are limited.
  3. Litigation-Using an Expert in No-Fault Recovery
    1. Gives the provider the highest monetary recovery.
    2. When a denial is received the No-Fault attorney is notified.
    3. Documents required to initiate the suit include copies of the bills and copies of the denials.
    4. The attorneys initiate the lawsuit.
    5. Usually within 2 months either an answer is received by your attorney or, in approximately 1/3 of the cases, the insurance company contacts the attorney to settle the suit. This settlement is usually between 60 and 80%.
    6. If an answer is received, the suit proceeds to the discovery phase.
      1. Our attorneys have relationships with many insurance companies so that the discovery is waived and a notice of trial is immediately filed.
        1. Many insurance companies do not address the suit or look at the case until it's "on for trial".
        2. When the trial date approaches, a large majority of the cases are settled.
      2. If discovery needs to be completed, a copy of the medical records are requested.
        1. Once discovery is completed the case is set for trial.
        2. Again, as the trial date approaches, a large majority of the cases are settled.
    7. If the case goes to trial, the provider is notified of the specifics and the trial date.
      1. The trials in the no-fault system are heard by the judge
      2. The judges are bound by case law which currently favors the provider
      3. We encourage our providers to appear and testify, which in most case strongly favors a good outcome for our clients
        1. In addition, once the insurance companies are aware that our providers come to testify, it often leads to larger and quicker settlements for that provider before trial.
      4. In order to defend a claim at trial, the insurance company is required to have experts present to testify which is a major expense. If the expert is not available, the insurance company loses the trial.
Our attorneys, who are expert in the no-fault system, will take every claim to its conclusion and get for our clients the highest recovery possible. We also provide advice to our clients in obtaining the best billing and collection systems and organizing their practice to achieve the maximal reimbursement.
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