NO FAULT REPRESENTATION FOR MEDICAL PROVIDER AND INJURED PARTIES
ARBITRATION FOR "INJURED PARTIES"
ARBITRATION FOR “INDIVIDUAL” CLAIMANTS
Please note that our representation is not exclusive to treatment providers and practitioners; we are also happy to represent individuals as claimants who have been denied benefits and wish to pursue lost wages and/or reimbursement for medical expenses in instances where the treating physician has not attempted to collect through litigation or arbitration.
To collect for lost wages, send us the following:
- Disability Letter from your doctor for the period of time we’re claiming
- Medical records supporting your disability claim
- Tax returns or a W2 form
To collect benefits, send us the following:
* Having received treatment, you will have “assigned” the right to collect your insurance benefits over to the doctor who treated you. You will need to revoke that assignment if you wish to attempt to collect the benefits on your own.
- Bills for every treatment/service we are arbitrating
- All denials associated with the bills
- All medical records
- Test results
- Hospital records
- And any other relevant records
* Please be advised that when we are arbitrating a case on behalf of an individual claimant (a non-assignee), we can attempt to collect benefits due for services from multiple treatment providers in one single arbitration case.
*TIP – PRESERVE YOUR RIGHT TO ARBITRATE!*
If your treatment provider has not submitted your bills to the insurance carrier, you should submit the bills yourself—within 45 days of service. Even after the insurance carrier cuts off benefits on the basis of an independent medical examination, it is important to make sure that your bills get sent in to the no-fault carrier. In order to arbitrate, most opinions and decisions hold that even after a cutoff, bills still need to be submitted in a timely manner.
Since 2000, the Law Offices of Jeffrey S. Kimmel has been handling no-fault insurance collections on behalf of all physicians, surgeons, chiropractors, physical therapists, and other healthcare service and treatment providers throughout New York and New Jersey. We cater to both small and large medical practice groups, as well as hospitals, surgery centers, and billing companies, and we offer the kind of personalized attention clients are unlikely to receive from larger law firms.
Having settled thousands of claims, small and large, we have collected for office visits, diagnostic testing, medical supplies, surgical procedures, neurological testing, psychiatric counseling, and various other types of medical services arising out of motor-vehicle accidents.
While we recommend arbitration as the most effective and cost-efficient means to recovery, we are fully prepared to litigate when necessary, and we have taken many disputes to civil court with favorable results.
A 1998 graduate of the Benjamin N. Cardozo School of Law, Mr. Kimmel has been counseling healthcare providers and dealing with all the major insurance carriers on a daily basis for over a decade. If you have the proper records, the only thing standing in the way of your successful collection is a small amount of routine paperwork.
ARBITRATION FOR MEDICAL PROVIDERS
I’m sure you’ve all heard the famous maxim used to emphasize the key element of success in business and real estate: “location, location, location!” Well, in my line of work, I’ve coined the phrase: “medical records, medical records, medical records!”
While many of my industry colleagues would have you believe that a winning no-fault collection case depends primarily on the attorney, I disagree. I have arbitrated thousands of no-fault disputes, and I firmly believe that the overwhelming majority of these cases are won and lost solely on the basis of the sufficiency of the medical documentation submitted.
Of course, the representation you choose is still very important. Can an attorney with little to no experience with no-fault collection cases regularly make mistakes and lose? Absolutely. However, even the most skilled and experienced no-fault collection attorney may lose at arbitration if he or she is not properly armed with the necessary documentation.
That said, when you submit your case to our firm, please provide us with as much documentation as you possibly can. For instance, in addition to all medical records and service bills in your possession, it is ideal to provide records from any and all referring physicians, as well as hospital and/or ER records, if applicable.
A great resource to contact to obtain such documents is the attorney handling a personal injury case on behalf of your patient. That attorney should already be in possession of all prior records, including those that may be difficult for you to track down. Overall, it is best to try to cover all bases before submitting your case to our firm; that way, you can be sure that we will be able to present a comprehensive treatment narrative within our application for arbitration, and this will greatly improve your odds of prevailing.
Now, this is not to say that our firm won’t take on your case if some documentation is unavailable. Truth be told, we have settled many cases with nothing more than a bill for services, an assignment of benefits, and the isolated test results or treatment records specific to the treatment or service we are arbitrating. For instance, we have won surgery cases with no medical records other than the surgical report, and we have won diagnostic testing cases with nothing more than an MRI report, and so on. However, we stress that your odds of success increase in tandem with each additional bit of relevant treatment documentation you can provide.
HOW IT WORKS:
1. After you provide us with the documentation, we submit the application to arbitration, and as long as we’ve demonstrated that you (the provider of service) deemed the treatment medically necessary, you will automatically be presumed to be entitled to recover the benefits.
2. The insurance carrier will then have the opportunity to answer, and they will bear the burden of establishing, via peer review of the records and/or independent medical examination of the patient) that the treatment was not medically necessary.
3. Even if the insurance carrier submits evidence allegedly establishing a lack of medical necessity (which is to be expected), we will then still have a chance to REBUT this claim by providing additional evidence in the form of a “rebuttal”.
If the patient is examined again after the insurance carrier’s independent exam, a physician’s letter further attesting to the medical necessity of the prior treatment may be all that is needed for a successful rebuttal.
1. Send us as much documentation as possible
2. Be prepared to rebut the insurance carrier’s claim of lack of medical necessity with further evidence or an additional letter attesting to medical necessity.
We do not store your new case submissions in a closet or bookshelf. Our staff will process your new submission immediately with a view towards filing the case within 24 hours of receipt of all documentation. I welcome your questions, and I invite you to call me anytime to discuss your collection needs. I respond to all calls, texts and emails personally and as soon as possible.While I cannot legally guarantee results for my clients, I can guarantee efficient service and personal attention.