Personal Injury Protection (PIP) Litigation

We secured an arbitration win, slashing a $83,000 claim to $625. The applicant, a major medical provider, filed an arbitration matter in the total amount of $83,625, alleging our client owed it for the claimant’s unpaid medical bills following a major motor vehicle accident. The claimant had been involved in the motor vehicle accident and sought payment for a series of medical treatments rendered post-accident. Counsel for the medical provider argued that the medical billing was never properly paid, therefore, payment of the claims was overdue. However, we successfully argued at the arbitration hearing that the applicant’s demand amount was greatly over exaggerated and that the amount in dispute must be limited to the appropriate fee schedule limit of $625.82. After arguments were heard, the arbitrator ruled in our client’s favor.

We were successful in having a New York No-Fault (PIP) action fully discontinued, with prejudice. The plaintiff, a major medical provider, filed suit in Kings County Civil Court in the total amount of $25,805.85, claiming our client owed it for the claimant’s unpaid medical billing. The claimant had been involved in a motor vehicle accident and sought payment for medical treatment. Counsel for the medical provider argued that, since the billing was never paid by the insurer, it was due in full—despite the fact that the same matter had previously been fully exhausted and was processed/handled in full compliance with the applicable medical fee schedule(s). While there were evidentiary issues in our client’s case, our arguments and position were strong. After negotiations and arguments, plaintiff’s counsel acquiesced to a full discontinuance of the matter, with prejudice.

We obtained full dismissal in a medical billings claim against our insurance carrier client in a New York No-Fault/PIP Action. The plaintiff, a major medical provider, filed suit in Kings County Civil Court in the total amount of $22,610.79, claiming our client owed it for the claimant’s unpaid medical billing. The claimant had been involved in a motor vehicle accident and sought payment for medical treatment. Counsel for the medical provider argued that, since the billing was never paid by the insurer, it was due in full—despite the fact that the same matter had previously been fully exhausted and denied on similar grounds. While there were evidentiary issues in our client’s case, our arguments and position were strong. After negotiations, plaintiff’s counsel acquiesced to a full dismissal of the matter. Thereby, our client was absolved from any fiscal liability in this action.

We secured the dismissal of a fraudulent claim against our insurance carrier client in a New York No-Fault/PIP Action. We argued the medical provider’s assignor was involved in a staged loss/fraudulent accident in order to obtain No-Fault/PIP benefits. In support of the defense, an SIU affidavit and the transcript of an Examination Under Oath (EUO) from the assignor were submitted, which included facts that casted doubt on the legitimacy of the accident. These included details such as the lack of an official police report, the insurance policy having been purchased right before the accident, and the inability of the assignor to remember key details of the accident. After a successful argument at the arbitration, the arbitrator ruled in favor of our client.

We successfully defended an insurance carrier in a New Jersey no-fault arbitration matter. The claimant, a pain management provider, filed an arbitration demand in the amount of $125,218 in connection with a baseline urine toxicology screen and subsequent presumptive and confirmatory testing performed on a monthly basis to monitor a patient’s medication regimen. We successfully argued that the extensive testing was being performed without regard to the needs of the patient. After arguments were heard, the arbitrator issued an award in favor of our client, finding that the excessive testing was not medically necessary, saving our client more than $100,000.

We successfully defended and submitted post-hearing arguments and secured dismissal of a New York no-fault arbitration matter. The applicant, a major medical provider, filed an arbitration matter in the amount of $361,601.62, claiming our client owed it for the claimant’s unpaid medical bills following a major motor vehicle accident. The claimant had been involved in the motor vehicle accident and sought payment for medical treatment for a series of treatments rendered while hospitalized, post-accident. Counsel for the medical provider argued that the medical billing was never properly nor timely denied, therefore, payment of the claims was overdue. However, we successfully argued at the arbitration hearing that the applicant’s client failed to provide the requisite statutorily required medical assignment-of-benefits form, assigning the hospital the right to sue on behalf of the injured party. After arguments were heard, the arbitrator ordered post-hearing submissions to be filed by both sides. After researching, drafting and filing a post-hearing submission, the arbitrator ruled in our client’s favor, thereby dismissing the matter based on the applicant’s total failure to submit the requisite form, saving our client hundreds of thousands of dollars.

The plaintiff, a major medical provider, filed suit in Suffolk County’s 3rd District Court in the total amount of $14,999.99, claiming our insurance company client owed it for the claimant’s unpaid medical billing. The claimant was involved in a motor vehicle accident and sought payment for medical treatment. Counsel for the medical provider argued that, since the billing was never paid by the insurer, it was due in full—despite the same matter having been successfully argued and won in arbitration in June of 2021. However, after successful arguments and motion practice, and without significant opposition by plaintiff’s counsel, the matter was dismissed, in full, by the court, which found that both res judicata and collateral estoppel applied. Therefore, the court found in full favor of our client and dismissed the suit and its accompanying complaint.

The action was brought against an out-of-state insurer based on the plaintiff’s failure to arbitrate. The plaintiff filed suit against a New Jersey insurance company over treatment that occurred in Florida. However, the subject policy and the laws of New Jersey require mandatory arbitration prior to initiating litigation. On the defendant’s motion to dismiss and compel arbitration, the court found that the doctrine of lex loci contractus applied, which required the plaintiff to comply with New Jersey law and policy and to submit to arbitration prior to filing suit. The court entered a final order dismissing the case and compelling the plaintiff to complete binding arbitration.

The applicant, a major medical provider, filed joint arbitration matters in the aggregate amount of $46,095.41, claiming our client owed it for the claimant’s unpaid medical bills. The claimant had been involved in a motor vehicle accident and sought payment for medical treatment. Counsel for the medical provider argued that the original denial basis was insufficient to deny the payment of the claims. However, after our successful argument at the arbitration hearing, our client’s policy of insurance was found to be completely and properly exhausted. Therefore, the arbitrator found in full favor of our client and denied the applicant’s entire claim, on both matters.

The arbitrations were commenced by medical providers against the respondent-carrier for non-payment of medical bills insofar as the policyholder and the claimant engaged in material misrepresentation in the procurement of the policy, and in the presentation of the claim. We submitted a defense brief that included numerous exhibits, including examination under oath transcripts, an affidavit from the respondent-carrier’s underwriting department and screenshots of insurance premium payments from the claimant to the policyholder. At the hearings, the defense argued that the respondent-carrier owed no duty of coverage insofar as the policyholder and the claimant engaged in material misrepresentation in the procurement of the policy and in the presentation of the claim. Specifically, the policyholder fraudulently obtained an insurance policy with the respondent-carrier on behalf of the claimant. The misrepresentation was deemed “material” insofar as the respondent-carrier would have charged a higher premium based on the actual garaging location of the insured vehicle and, moreover, would not have otherwise insured the claimant. The arbitrator held that the respondent-carrier established, by a preponderance of credible evidence, that the instant loss involved fraud and misrepresentation in the procurement of the insurance policy; the policyholders’ misrepresentation with regard to the ownership, operation and garaging of the insured vehicle was material; the respondent-carrier would not have issued the policy if the facts had been disclosed by the policyholders, and that the respondent-carrier was justified in denying the claim.

We successfully argued and obtained a full dismissal of an arbitration matter filed against a major insurance company. ​The plaintiff filed it, claiming the insurer owed payment for unpaid medical bills. He alleged the injuries arose from a motor vehicle accident on February 28, 2017, and sought payment for medical treatments provided to him in the amount of $92,043.28. His position was that the entire amount was owed as our client had not reimbursed the medical provider for the services/surgery rendered. The defense countered that the treatment rendered was not medically necessary and presented documentation from an independent medical peer review of the plaintiff’s medical claims record to support that position. The arbitrator heard arguments, concluded that our argument was persuasive, and found in full favor of our client.

We successfully secured dismissal of a New York no-fault/PIP arbitration commenced by a medical provider against a major insurance carrier for non-payment of medical bills. At the hearing, the carrier argued that the provider was ineligible for reimbursement of the disputed charges because it was not licensed in New York State with the Department of Education and the Department of State when the services at issue were rendered. Under the New York no-fault/PIP regulations, a provider of health care services is not eligible for reimbursement under the insurance law if it fails to meet any applicable state or local licensing requirements. In support of the threshold defense, we submitted copies of printouts from these Departments as conclusive evidence that the provider was not properly licensed in New York State when the services were rendered and was therefore ineligible for New York no-fault reimbursement.

In an arbitration matter filed against our insurance company client, the applicant claimed our client owed him for the unpaid medical bills of the claimant totaling approximately $20,000. The claimant was purportedly involved in a motor vehicle accident and sought payment for medical treatments/surgery. It was argued that our client owed the applicant’s client for the medical services, despite New York State being the improper venue for hearing such a claim. The policy of insurance was written in Pennsylvania, the accident occurred in Pennsylvania and the claimant lived in Pennsylvania. The applicant, the provider of the medical services, and the medical facility where the services were rendered were all located in New Jersey. There was no apparent connection to the state of New York, other than the fact that the surgeon performing the surgery maintains an office there. The arbitrator agreed that this single contact was insufficient to confer jurisdiction on the New York State no-fault system to adjudicate these no-fault claims in the state of New York.

Obtained a dismissal at trial in Civil Court of the City of New York, Queens County. ​The plaintiff, an acupuncture facility, alleged wrongful denial of personal injury protection/no-fault benefits relating to acupuncture services rendered to its assignee, a claimant who sought benefits under the defendant-carrier’s policy. The trial judge granted dismissal of the complaint on the basis of the carrier’s defense, that payments were issued in accordance with the applicable fee schedule and, therefore, nothing further was owed to the plaintiff.