You provided excellent medical treatment to a patient after a car accident, yet, the automobile insurer denied full and fair reimbursement of your medical bills. But there’s hope. The Harrell Law Firm can pursue maximum recovery for your services from the PIP carrier through PIP arbitration. We have many years of experience and thoroughly understand the medical issues, as well as the unique insurance industry standards, rules and regulations that apply in New Jersey. We appreciate your concerns as a doctor and health care provider. You’ve done your part and deserve full compensation. Our goal is to seek the maximum you are entitled to under the law.
What is PIP Arbitration?
Under New Jersey’s no fault insurance system all New Jersey drivers are required to maintain Personal Injury Protection or PIP benefits. It covers costs for medically necessary treatment for injuries causally related to the motor vehicle accident. In addition, the state created an alternative resolution system to settle disputes between medical providers and insurance companies about PIP reimbursement. New Jersey contracts with Forthright to administer the New Jersey No-Fault PIP Arbitration Program. It enables doctors and other healthcare providers to resolve disputes efficiently. PIP cases are administered under rules promulgated by the New Jersey Department of Banking and Insurance.
What is the PIP Arbitration Process and How Does it Work?
In a PIP Arbitration, a neutral third-party arbitrator resolves a disagreement between the insurer and the doctor or other health care provider. PIP Arbitrators are New Jersey lawyers familiar with medical and insurance law. You have a right to be represented by a lawyer in the hearing.
We can serve a demand for arbitration on the insurance company that is disputing your claim. Insurers doing business in New Jersey are required to register with Forthright–and make available an address for the service of an arbitration notice. Claims exceeding $1,000 are heard in a live, video-facilitated arbitration hearing arranged by Forthright according to the State’s PIP Arbitration Rules. Claims under $1,000.00 are decided after each party provides written legal argument and supporting papers.
You have the right to be represented by an attorney, as does the insurance company. Typically, it is not necessary for a doctor making a claim to be present for the hearing unless the medical necessity of treatment is an issue. However, a lawyer can present proof and arguments on behalf of the doctor.
A PIP arbitration is less formal than a courtroom. Nonetheless, the arbitrator’s decision is binding on all parties. Appeals from the arbitrator’s decision to the New Jersey Superior Court is permitted but rarely invoked. Further, the relative informality of the hearing, the video format, and the general nature of the arbitration process makes the proceeding less expensive, quicker, and less burdensome for doctors and insurance companies than a court case. Additionally, if the arbitration is successful, all of the legal fees and costs are reimbursed by the insurance companies.
The Harrell Law Firm Can Help
Preparation and experience are the keys to winning at PIP arbitration. First, the doctor needs to establish proof of their right to insurance proceeds. This is done by presenting a patient-signed assignment of benefits form. Next, your attorney will establish another essential element–that arbitration is appropriate–by showing you have exhausted all necessary internal appeals of your claim to the insurance company.
As a preparatory matter, we advise clients on important topics such as medical coding and how best to navigate internal insurance company appeals. Insurers will attempt to prove the lack of medical necessity for disputed treatments, unauthorized out-of-network care, incorrect billing codes, and other reasons to deny full payment. To maximize recovery, we can present the following:
- Treatment records
- Proof of co-morbidities
- The necessity of medical care
- Treatment within policy limits
- Proper medical-service coding
- Pre-certification of medical care
- Compliance with billing regulations and Appeals process
- Proof of usual and customary rates for codes not on the New Jersey fee schedule
Contact us for a free case evaluation
Harrell Law Firm works with doctors and other healthcare providers to ensure they are fully compensated for the treatments they provide. Attorney Leigh A. Raffauf heads our PIP arbitration practice. With sixteen years of experience representing insurers and doctors in litigation and arbitration, she is a relentless advocate for her clients–seeking maximum recovery for doctors and other healthcare providers. Our firm serves the Central and South New Jersey regions of Union, Middlesex, Monmouth, and Ocean Counties. Call today for a free consultation.