Long Island Accident Lawyer Jeena R. Belil Comments on Revisions to No Fault Regulation

The wording of 65-3.8 (b)(4) continues to act as both a sword and a shield for the insurance companies to the detriment of both their insureds and treating health care providers alike. To wit:
      
       (4)  If the specific reason for a denial of a no-fault claim, or any element therof, is a medical examination or peer review report requested by the insurer, the insurer shall release a copy of the report to the applicant for benefits, the applicants attorney, or the applicant's treating physician, UPON THE WRITTEN REQUEST OF ANY OF THESE PARTIES
 
The troubling issue that has arisen time and time again is that most carriers have failed to provide any specific information on their NF-10's, other than "See Annexed" or "Denied based upon Peer Review of Dr. _______" in box 31 without going into further detail. Many insurance companies are taking an adversarial position contrary to the spirit of the No Fault Regulation and purposely withholding these reports simply because the language allows them to do so.  

The patient may then receive this denial and without questioning, cease all further medical treatment without asking for a copy of the peer review report in writing in order to determine whether the denial of benefits actually comports with the conclusions made by the peer reviewer.  
Many arbitration decisions have overturned these denials and even their accompanying peer review reports for their lack of substance and credibility.
The very fact that this language exists in the Regulation puts the insurance company in a adversarial position to its insured, which is incorrectly sanctioned by the Insurance Department.

Thank you for your time and review of my commentary,

Jeena R. Belil, Attorney at Law