80% of the billed amount can be
Florida appeals court ruling on Progressive vs Back on Track regarding 80% PIP reimbursement rates and statutory schedule of maximum charges interpretation.
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July 2022 Articles
19 articles published in July 2022
Avenues of Reimbursement
Explore two avenues of reimbursement in no-fault insurance: fee schedules vs. reasonable and customary charges. Florida court ruling on expert testimony methodology.
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The failure to comply with record keeping requirements
Florida court rules that record keeping violations don't justify denying claims when treatments are medically reasonable and necessary, protecting patient access to care.
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Competing Assignees?
Florida court case examining the English Rule of priority between competing assignees in no-fault insurance claims, distinguishing assignees from insureds in payment order disputes.
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Fla pre-suit requirement is more demanding than thought
Florida's demanding pre-suit requirements for PIP claims now require precision in demand letters, moving beyond substantial compliance to exact amounts.
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Fla 35-day timely submission
Florida's 35-day billing submission rule compared to NY's 45-day requirement - appellate court ruling against providers and strategic considerations for attorneys.
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Can an insurance carrier sue for “overpaid” PIP attorneys fees?
New Jersey court rules insurance carriers cannot sue attorneys for "overpaid" PIP fees under IFPA when payments were regulatory penalties, not policy benefits.
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The Ins Law 5106(c) trial de novo
Learn about Ins Law 5106(c) trial de novo proceedings in NY no-fault insurance disputes. Expert insights on litigation strategy and settlement tactics.
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Justification for a lt
New York no-fault case shows how healthcare providers can justify failure to comply with insurance verification requests during claims processing.
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Policy exhaustion -or was it?
New York court ruling shows insurance companies must properly prove policy exhaustion claims with adequate foundation for payment records under CPLR 4518.
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The if I was there EUO dance
Court decision analyzing EUO no-show affirmations in no-fault insurance cases, questioning sufficiency standards under Parisien v Ameriprise ruling.
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Acupuncture
Court rules State Farm properly paid acupuncture claims using workers' compensation fee schedule for chiropractor services under New York no-fault insurance law.
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Insufficient excuse
Court rules medical provider failed to justify submitting no-fault claim to wrong insurer, despite claim form allegedly bearing correct carrier's information.
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Mutual rescheduling and its risks
Learn how mutual rescheduling of EUOs can impact disclaimer timeliness in NY no-fault cases. Court ruling shows risks when insurers can't prove mutual rescheduling occurred.
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EUOs/ $5000
Court rules healthcare providers cannot demand $5,000 upfront payment as condition for attending examinations under oath in no-fault insurance cases.
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A medical necessity a** beating
Court ruling on no-fault insurance benefits case where plaintiff successfully obtained summary judgment for unpaid medical bills totaling $44,573.86.
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Danger of rescheduling an EUO after the second no show
New York court ruling warns insurance companies against rescheduling EUOs after second no-shows, potentially waiving denial rights in no-fault claims.
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Forum Non Convienens not provider
Court denies forum non conveniens motion in NY no-fault case due to inadmissible hearsay evidence and procedural defects in proof presentation.
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Post EUO demands
State Farm v Burke Physical Therapy case analysis on post-EUO document demands and verification requirements under New York no-fault insurance law.
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