No-Fault Arbitration

Documents Required For No Fault Arbitrations

On March 5, 2002 the New York State Insurance Department issued new regulations dictating that all new arbitration filings contain all evidence at that point in time. therefore, it is imperative that all files being sent to this office to attend all of the evidence required to win the case. I have compiled a list of all documents necessary in order to win an arbitration.

Medical supplies - it is becoming increasingly more difficult to win these types of cases at arbitration. Therefore, I have summarized what is required for each type of supply.

For all arbitrations we need to have the following:

• Properly fee scheduled bills detailing the outstanding amount owed. Please note that the new regulations ((link to NYSID)) state that if a bill is submitted over fee schedule then no attorney fees will be awarded. Please note that the provider will be responsible to make up the amount of lost fees. IT IS IMPERATIVE THAT THE BILLS ARE PROPERLY FEE SCHEDULED PRIOR TO THERE SUBMISSION TO THIS OFFICE.
• Assignment of benefits - this must be made out to the provider and must not contain language that the patient will be personally liable if the case is lost ((see attached assignemtn))
• Modification of assignment - for those cases in which there was an assignment which had the 'personally liable' language in it you can submit a modification ((see attached))
• Check for $40.00 for each case made payable to the American Arbitration Association. Please note that if you submit cases in bulk you may be able to bulk the payment so that you just submit one check to cover all filing fees.
  
• Denial - a denial for each bill or set of bills must be submitted, if a denial was issued. We need this in order to verify if the denial is timely and to find out if there are any issues that need to be addressed prior to filing as we would not be allowed to submit additional documents after the case is filed.
• Police report - if available

Neurological testing -

The regulations clearly state that in order for a test to be compensable it must be medically necessary. The common rationale among arbitrators is why perform a test if the result will not change the course of treatment. Therefore, unless it can be proven that the result will alter the treatment plan the chances of winning are greatly reduced. With that being said, in order for the Law Offices of Michael Samuel to properly prepare your case we would need a detailed letter of medically necessity establishing how the course of treatment has changed. We also need an initial medical report detailing the patients symptoms after the accident and at the initial office visit.

• initial office visit - this should include a detailed history of how the accident happened, a history of all subjective and objective complaints, any objective results of tests performed at the visit, i.e. Rombergs test, etc., and a treatment plan.
• conservative physical therapy - arbitrators need to see that the symptoms are not merely due to inflammation which may subside in a short period of time, but are of a long standing nature. Therefore, we need to show that the patient was receiving some type of physical therapy from the time of the initial office visit until the time of testing. All notes must be submitted so that we can 'make the case' that the testing was vital to the recovery of the patient.
• Follow up visit - without a follow up visit it is impossible for the arbitrator to know whether the patients complaints diminished due to the physical therapy. Therefore, a follow up performed by a neurologist is necessary. If the patient has radiating symptoms it is important to make note of this fact.
• Test results - without test results we can prove that the test was actually performed, therefore, we need to have all of the graphs and findings of the test

MRI testing

• Initial report - As with neurological testing we need an initial report containing all of the things listed above.
• Letter of medical necessity - this should clearly state why the MRI was necessary, i.e. what symptoms led the doctor to prescribe this test and how will the result change the treatment plan, if at all, and why.
• Test results - this is necessary to show that the test was done
• Follow up reports - see above
• Physical therapy notes - we need to show that the patient was receiving some type of physical therapy from the time of the initial office visit until the time of testing. All notes must be submitted so that we can 'make the case' that the testing was vital to the recovery of the patient.

Medical supplies

• Initial report - this should include a detailed history of how the accident happened, a history of all subjective and objective complaints, any objective results of tests performed at the visit, i.e. Rombergs test, etc., and a treatment plan.
• Prescription - this should be from the referring doctor
• Delivery receipt - this should be signed by the patient
• Measurements - this applies to any custom fitted device
• Wholesale invoice - the regulations state that you can only charge 150% of cost, therefore we need this to establish the cost
  
• Follow up reports - this will let the arbitrator know what complaints that patient had just prior to the supplies being prescribed. Acupuncture
• Referral - If the patient was referred from another doctor we need the referring doctors medical report
• Initial acupuncture report - This should state whether or not the treatment is due to a motor vehicle accident, objective and subjective complaints, treatment plan, diagnosis, etc.

NEW CASE EVALUATION

Please submit information for any case and a lawyer will contact you promptly

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