Source: http://www.jdsupra.com/post/documentViewer.aspx?fid=9b22f19f-65d1-41b2-a8e8-7946662034d0
Timestamp: 2017-06-28 07:53:11
Document Index: 527301228

Matched Legal Cases: ['Art. 65', 'Art. 65', 'Art. 65', 'Art. 65', 'Art. 65', 'Art. 65', 'Art. 65', 'Art. 65']

The Life of a New York No Fault Claim (Pre-Litigation) | Long Island Attorney Jeena Belil - JDSupra
The Life of a New York No Fault Claim (Pre-Litigation) by Long Island Attorney Jeena Belil
Ever wonder what happens to your New York No Fault bill BEFORE it gets litigated or arbitrated? Here's a handy flow chart to show you what happens at the claims desk.
Download PDF Reg. 68, Art. 65-3.8(f) Westchester Med. Ctr. v. NY Cent. Mut. 262 A.D.2d 553 COVERAGE? DENY NO NO NO, On the face of it (eg. concurrent or prior IME cutoff) YES YES YES DENY NO Reg. 68, Art. 65-3.9 Presbyterian Hosp v. Amer. Tran. 287 A.D.2d 699 (2001) Mount Sinai v. Triboro Coach 263 A.D.2d 11 (2d Dept. 1999) Reg. 68, Art. 65-3.5(c) per Ins. Dept. opinion letter Westchester v. Trav. J. Franco, Nassau County Reg. 68, Art. 65-2.4 (c) No-Fault endorsement Reg. 68, Art. 65-3.8 Presbyterian v. Maryland Casualty 90 NY2d 274 (Ct. Apps) Zappone v. Home Ins. 55 NY 2d 131 (1982 Ct. Apps.) Central Gen. Hosp. v. Chubb 10 NY2d 195, 687 NE2d 413 {Time irrelevant} {Within 30 days and per form} {Within 30 days & per form} {Within 30 days, else 2% interest} {Within 30 days, else 2% interest} {Within 30 days and per form} Reg. 68, Art. 65-3.5(d) Westchester Med. Ctr. v. NY Cent. Mut. 262 A.D.2d 553 Reg. 68, Art. 65-3.6(b) Matter into suspense – no further obligation until information received Submitted in time? Medically necessary & consistent with Fee Schedule? YES YES YES LIFE OF A NO-FAULT BILL Need Verification DENY DENY Request Verification within (old) 10 business days (new) 15 business days Received information within 40 days? EUO IME PEER REVIEW DOCUMENTATION NO Medically Necessary? NO PAY 2nd verification request within 30 days? Received info? NO NO Subsequent denial bad 2% simple interest Reg. 68, Art. 65-3.5(b) PAY Document hosted at http://www.jdsupra.com/post/documentViewer.aspx?fid=9b22f19f-65d1-41b2-a8e8-7946662034d0