It was not proven that the surgery was not medically necessary
New York no-fault medical necessity denial case where insurer's peer review expert failed to consider all medical records, highlighting common arbitration challenges.
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October 2017 Articles
17 articles published in October 2017
The electrodiagnostic service was not medically appropriate
Court case where electrodiagnostic testing deemed medically unnecessary due to lack of diagnostic dilemma, with credible expert testimony shifting burden to plaintiff.
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Failure to cooperate
Court ruling on no-fault insurance coverage denial due to provider's failure to cooperate at examination under oath and unlicensed practice violations.
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Attacking the experts
Court allows cross-examination of plaintiff's expert about 30-year-old suspension from chiropractic school, ruling past misconduct relevant to credibility when witness claims expertise.
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An expert who saw plaintiff once may testify
New York court rules on expert witness testimony limits for non-treating physicians in personal injury cases involving spine and knee injuries.
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Preclusion of bio-mechanical opinion
Dovberg v Laubach case analysis: Second Department precludes biomechanical expert testimony lacking proper foundation in peer-reviewed literature and empirical data.
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Priority of payment
New York appellate court identifies complex issues in no-fault insurance priority of payment disputes, highlighting challenges in determining proper provider reimbursement order.
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Statute of Limitations – three versus six?
Jason Tenenbaum examines a curious amicus brief filing by American Transit Insurance Company in a statute of limitations case involving governmental entities.
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Another silly appeal
Court properly grants renewal motion after counsel's part rule violation, confirms Bronx venue based on plaintiff's residence at case filing
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A new 68.6 is coming next year
New Jersey implements crucial no-fault insurance fee schedule regulation 68.6 in 2018, addressing long-standing billing inconsistencies and overbilling practices.
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2309 again – nothing different today
New York's First Department continues its inconsistent approach to CPLR 2309 certificate of conformity requirements, allowing technical defects to be corrected nunc pro tunc.
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When EUO counsel is not an attorney
New York court ruling on EUO counsel's attorney-client privilege when serving dual investigator roles in insurance cases - key precedent for discovery disputes.
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First sighting of 120-day rule
TAM Med. Supply Corp. case introduces new questions about timing requirements for 120-day denials in New York no-fault insurance disputes.
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New trial with a twist on a medical necessity claim
NY court ruling on medical necessity claims allows expert testimony from witnesses who didn't prepare peer review reports, clarifying trial evidence rules.
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Repriced CPT Code 64550
Court upholds insurance carrier's repricing of CPT code 64550 to 97014 in no-fault case, demonstrating proper application of workers' compensation fee schedule.
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Untimely EUO demands
New York Court clarifies 30-day rule for EUO requests in no-fault insurance cases, declaring untimely demands nullities under Insurance Regulations 65-3.8(l) and 65-3.5(b).
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Acupuncture that is broken down by code
Court decision analysis on acupuncture billing codes in NY no-fault insurance cases, examining fee schedule defenses and discovery requirements for CPT codes 97810 and 97811.
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