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Insurance Companies Abusive Tactics Of Claim Avoidance Hurting Legitimate Healthcare Providers And P


On behalf of Licatesi Law Group, LLP posted in Real Estate on Tuesday, July 8, 2014.

In New York, No-fault laws were enacted in 1974 with the goals of:

(1) Ensuring that all automobile accident victims are promptly treated for personal injuries sustained in the accident, regardless of fault or negligence of the accident;

(2) Reducing the burden of lawsuits on the court system; and

(3) Providing insurers with cost containment

New York’s No-Fault Insurance Law limits the ability of automobile accident victims to sue for damages beyond their No-Fault benefits. The concept is that No-Fault will provide immediate coverage for medical expenses and economic loss, in exchange for making it harder for an injured person to sue for additional damages, by requiring that an accident victim sustain a “serious injury,” as defined by statute, before that person can seek damages in a court of law. This gave insurance companies a huge benefit since accident victims were greatly restricted in their right to recover for their personal injuries.

In general practice, when a person is injured in a car accident and is in need of medical treatment, health care providers who accept No-Fault will treat these individuals in exchange for an assignment of benefits. Meaning, the injured victim will generally not incur out-of-pocket expenses for medical treatment, because their treating healthcare providers will bill the insurance company directly for the treatment provided.

Unfortunately for the healthcare providers who accept No-Fault insurance, coverage of medical services are NEVER pre-authorized and are all too often DENIED by the insurance companies – leaving doctors with unpaid bills for services they have already provided. If they wish to get paid for their services, the only course of action left for these healthcare providers is to bring a proceeding in either court or in arbitration for reimbursement. Of course, they incur even further costs associated with this.

In light of many of the illegal, adversarial, and controversial tactics implemented by insurance companies in their attempts to avoid reimbursement of legitimate claims, only 1 out of 10 healthcare providers currently accept No-Fault insurance. In turn, this has severely restricted a personal injury victim’s abilities to be treated by a healthcare provider of their choice. Shouldn’t we all have a say in the management and care of our own health? Does being a car accident victim mean that we waive those rights, despite having to pay absurdly high premiums on our automobile insurance?

For over twenty-five years, Rubin & Licatesi has assisted No-Fault healthcare providers and personal injury victims in combating insurance companies’ abusive tactics of claim avoidance. Regrettably, because of insurance companies’ infinite financial capacity, and heavy lobbying presence, the current No-Fault laws have provided these insurance companies with an arsenal to routinely engage in such bad-faith schemes. The deadliest weapon thus far utilized are Declaratory Judgments and/or RICO Actions that are initiated by insurance companies, usually in Federal Court, to substantiate frivolous Mallela corporate status allegations of fraud.

Through these Declaratory Judgment and/or RICO Actions, which can cost a healthcare provider hundreds of thousands of dollars to defend, No-Fault insurance carriers have been able to put an economic noose on legitimate medical practices. Disingenuously, insurance companies will often use their ability to withhold millions of dollars in outstanding claims, to then support their basely allegations as a pretext to say that laymen are “siphoning profits” from these lawful medical practices.

Regrettably, the Department of Financial Services has failed to take appropriate action to prevent and/or regulate these flagrant abuses that are in direct contravention of the intentions of the No-Fault scheme. This inaction only further propels the cycle of insurance companies’ bad faith tactics, which in turn, detrimentally impact innocent healthcare providers and victims of automobile accidents.

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