In today's law journal…

The Fee Schedule Defense: A Flawed Strategy in No-Fault Insurance

No-fault insurance carriers often rely on various defenses to limit their payment obligations to medical providers and injured parties. One particularly controversial strategy involves invoking the “fee schedule” — the regulatory framework that sets maximum allowable rates for medical services under New York No-Fault Insurance Law.

However, as Attorney Jason Tenenbaum explored in a detailed analysis for the New York Law Journal, this defense strategy creates significant problems when insurance carriers fail to follow proper procedures. The timing of denials and the validity of claim rejections play crucial roles in determining whether carriers can legitimately invoke fee schedule limitations.

Understanding these procedural requirements is essential for both medical providers seeking fair compensation and injured parties navigating the complex world of no-fault insurance claims. The consequences of improper claim handling can be substantial, often requiring carriers to pay amounts that exceed standard fee schedule rates.

Jason Tenenbaum’s Analysis:

In today’s edition of the New York Law Journal, I discuss why the “fee schedule” defense is anything but a defense. The article is entitled: “Is Fee Schedule Application Really a Defense to a No-Fault Claim?” and begins as follows:

“Perhaps one of the most vexatious and unjust situations in no-fault practice involves the insurance carrier who is compelled to pay a medical provider or injured person an amount for a service or supply that is in excess of the maximum allowable rate under the fee schedule, due to the insurance carrier’s failure to issue a timely or otherwise valid denial.”

Click on the above link to read the remainder of the article.

Key Takeaway

When insurance carriers fail to issue timely or valid denials of no-fault claims, they may lose their right to invoke fee schedule limitations. This procedural misstep can result in carriers being compelled to pay amounts exceeding standard rates — a costly consequence of improper claim handling that highlights the importance of following established no-fault procedures.

Legal Update (February 2026): Since this 2010 analysis, New York’s no-fault fee schedules and reimbursement rates have undergone multiple revisions through regulatory amendments and Department of Financial Services updates. The procedural requirements for invoking fee schedule defenses and denial timing provisions discussed in this post may have been modified through subsequent regulation changes. Practitioners should verify current fee schedule rates, procedural requirements, and denial timeframes under the most recent regulatory framework.