Long Island No-Fault (PIP) Insurance Law Attorney

When you work with the Law Office of Gregory A. Goodman, P.C., you receive benefits such as:

• A thorough review and legal analysis of each claim: Our firm methodically reviews each claim on a case by case basis to determine which forum and course of action would bring about the best results for your facility.
• Our attempts to settle cases before litigation: Based on our legal analysis and with client authorization, we will attempt to settle each claim before ever placing the claim into litigation or arbitration.
• Arbitration of medical necessity cases: Arbitration is a practical forum to prosecute denied claims, provided you have experienced legal representation, your case is well-organized for presentation, and you have strong documentation to support the necessity of the services you rendered. One benefit of arbitration is that it can be resolved much more quickly.
• Expedition of litigious cases: Should we determine that litigation is the proper forum, we will implement our “Active Litigation Policy,” which pushes your case in order to get you paid faster.
• Free consultation and updates on important changes in the law: We will keep you informed and help you retool your intake and billing procedures to get you paid on your future cases. We can send one of our partners to your place of business to train or instruct your employees on how to process future claims.
• Direct access to partners and vital information when you need it: We keep an open line of communication with our clients. When a situation arises in the collection of your no-fault bills, you will have complete access to a partner or employee with specific knowledge of your files to get the answers you need promptly.

Did You Provide Healthcare without Being Paid for It?

Just like patients, insurers abuse healthcare providers by using examinations under oath to deny, delay, and not pay viable claims submitted by legitimate healthcare practitioners. This can cause a significant financial strain on that provider. A provider EUO request can essentially freeze any and all pending payments.

It is extremely important to forward any provider EUO request to your attorney. Your attorney must be competent, skilled, knowledgeable, and experienced in this area of law. An insurance carrier may use an EUO request to look into your corporate structure, hoping to keep you from showing up and thereby not having to pay you for all bills submitted. In fact, there have been a number of carriers that will drop their EUO request once you inform them and they know you are serious of attending.

Where Are EUOs Held?

Most insurance carriers and their attorneys will schedule the EUO at a location convenient to their attorney’s law office, but you are entitled to have the EUO anywhere that is convenient for you, so long as you object to the carrier’s location in your response—otherwise you will waive this right.

What Are Insurance Carriers Looking for at an EUO?

The insurance carrier will typically ask you questions about your knowledge and treatment of the patient(s), including the type of treatment your facility rendered to them and the medical necessity of the services provided. An insurance carrier may also wish to inquire into your billing practices, the CPT codes you utilize and bill for, and frequency of billing. They will most likely ask questions pertaining to the names of your employees, whether they are employees or independent contractors, and how you get your referrals.

11 NYCRR § 65-3.2 (c) states an insurance carrier can only delay payment of a claim to pursue investigations solely for good cause, so the “good cause” they may use could be implying your practice exhibited behavior tantamount to fraud. You need to be represented by a skilled, competent, and experienced law firm to protect your rights.

Are You Entitled to Know What Information the Carrier Wants Before Sitting for an EUO?

The short answer is yes—the better answer is you should be. The developing case law seems to support disclosure of said information. Although most insurance carriers and their attorneys generally and routinely refuse to give you information pertaining to the basis and reason for said EUO request prior to you appearing, there is some developing case law requiring said production. As such, you need an attorney who is knowledgeable about the law and a law firm that has experience arguing these issues before a court or arbitrator.

Diagnostic Testing

If your insurance claim is being denied with a requirement to submit diagnostic tests, let our firm help. While they may suggest reasons for why there are issues with the test, the truth is most of them simply don’t want to pay.

We have helped providers prove the medical necessity of diagnostic tests such as:

• MRIs
• pf-NCS exams
• EMG/NCV
• ROM/MMT