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.
11 Responses
I am writing a piece for a high school news paper that focuses on legal issues. It starts like this:
“Certainly one of the most vexatious and unjust situations in no fault practice involves paying premiums to insurance companies when the insurance companies know they are going to find some [] excuse not to pay benefits. What makes it more horrible is that the State of New York — your horrendous bought and paid for government — forces you to do this.”
Tell me how you really feel Ray… In all seriousness, I may disagree with some of your assertions, but my article involves the burdens of proof and certain litigation and arbitration based realities. It has nothing to do with whatever gripes that practitioners might have with their adversaries in no-fault litigation. So, I think your comment was a little off point.
Fee schedules are subject to interpretation. The question of whether coverage is triggered by the occurance of a legitimate automobile accident is much more clear.
And therefore a traverable issue of damages.
I feel that it is a very good article. Well written. Knowledgeable. A great piece of legal scholarship. It gives both sides of the issues arguments and understanding. What I would expect out of you. That is why I think you are an up and comer as a lawyer.
My comment was on point though. The point was the dramatics of your opening.
The poor multi billion dollar insurance company the victim of injustice — not hardly.
Thanks J.T. I work so hard — well maybe not that hard — to act like a deranged nut and just because someone speaks a little french — oh he’s Mr. Riveting.
Well here — “French Fries in gay Paree” — there is culture.
JT, the Spanish speaking dude is just a spam bot. In fact, I would delete his link since the site might have a trojan. I would gather the bot is programmed to comment in every blog on lisquared, referencing the visted website URL to make the comment appear legit. Bernie, how dare you?
I know. I find some of these spam posts to be quite interesting. What is interesting is that some of them actually look legitimate, until you take a deep look into it. But, you are right about the Trojan virus. I did not even think of that. I will delete the spam. I think one day I am going to devote a blog post to my favorite spam.
I finally had the chance to read your article, well done. However, I disagree with our position. Requiring the medical provider to establish compliance with fee schedules prima facie– a question which is subject to interpretation– would incentivize the insurer to sit on claims it determines are valid, thereby requiring the provider to sue on the claim and meet the heavy threshold burden.
Since statutory interest is no longer compounded and is now stayed assuming action is not brought quickly, said interest is not remotely enough to temper such incentive.
Sun,
You raise a valid point. I would note that insofar as bad faith actions are probably looming on the horizon in first-party PIP matters, there might be a remedy should the abuses you allege come to fruition. Just so everybody knows, I do not in any way endorse, importune or desire bad faith actions. I am just predicting what the future may have in store for us.