No-Fault

Did You Have to Pay Your Doctors Out of Your Auto Accident Personal Injury Settlement?

It’s the ultimate gut-punch when you are injured in a car accident.  Your No-Fault carrier decides to cut off your medical benefits (that you pay for! Don’t get me started) in the middle of your treatment. Your medical provider tells you or your lawyer, “Sorry, I can’t treat you any more because you were denied….unless you sign this lien against your settlement proceeds.” What can you do?  You feel stuck. You want to keep treating because, holy crap, you are in pain. You may ultimately need surgery. Your No Fault insurer doesn’t care. So, what can you do?

Eight Unit Rule Applies to Each Individual Provider Per Day

A nice win for New York No-Fault Chiropractors, Physical Therapists and Massage Therapists.  The “eight unit rule” under the Worker’s Compensation Fee Schedule applies to each individual practitioner for each day, not the total of all modalities on a given day.

This is a case of first impression, meaning, no other court decisions before this one has addressed this issue. We will need to watch and see if this case is appealed and, if so, what the ultimate outcome will be, but for now, each individual provider will get to bill a total of eight units per day.

Examinations Under Oath and Insurance Company Silliness

I recently represented a Licensed Massage Therapist at an Examination Under Oath (or EUO, for what should be obvious reasons).  Present at the unusually long conference table were the typical insurance carrier archetypes I know so well: the pleasant questioning attorney for the insurance company, the stone-faced and silent SIU representative, the court reporter with her mysterious mini-typewriter and stacks of exhibit tabs and four freshly-minted insurance lawyers who were being trained in “Insurance Fraud 101.”

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