Surgicare of Englewood Cliffs v. Allstate Ins. Co., (Law Div. 2009)

Insurance — medical expense benefits

The DPR's award in this dispute regarding the defendant's denial of payment for a discogram is vacated since the procedure was medically necessary and the certified professional coder used by the defendant to determine Usual, Customary and Reasonable ("UCR") fees does not have the requisite expertise to determine whether a fee charged is "reasonable" and her audit reports, without competent testimony, do not establish a basis for rejecting the provider's chargers for treatment.

Case Law Alert - 1st Qtr 2010