No-Fault Cases
We represent radiologists, neurologists, orthopedists, physical therapists, chiropractors, acupuncturists, and medical supply companies with knowledge and dedication. We achieve excellent results.
We specialize in handling no-fault claims in arbitration. This is the fastest and most efficient method of prevailing in the no-fault arena, and our attorneys have specialized in arguing cases in arbitration hearings for almost twenty years. We know each of the over 130 arbitrators and are aware of which arguments each of them find most persuasive, based on their prior awards and personalities.
No-fault is an area of law that changes rapidly. Every month there is new case law that affects the results in arbitration. We pride ourselves on being more up-to-date on this law than our adversaries are. We review new case law every day, and in the hearings we raise new legal arguments before the insurance carrier attorneys are familiar with the court cases.
Our Brooklyn No Fault firm is also known for regularly and successfully appealing arbitration awards to the master arbitrator and, when necessary, into court.
Our attorneys correspond with insurance companies, and when necessary accompany the client to Examinations Under Oath. As these EUOs are a burden on you and take your valuable time away from your patients, we challenge the insurance carriers to articulate an actual reasonable basis for their demand before agreeing to allow you to attend.
Providers across Brooklyn, Brighton Beach, and Garden City face constant barriers in obtaining timely and fair compensation for treatments rendered under New York’s no-fault insurance system. Claims that should be processed promptly are often delayed, underpaid, or denied outright. Routine treatments are flagged for “medical necessity” reviews, and insurers frequently use technicalities like untimely submissions or alleged policy breaches to avoid payment. These tactics interfere not only with cash flow but also with the continuity of patient care.
A no-fault lawyer helps eliminate those financial and procedural disruptions. With experience challenging insurer delay tactics, disputing vague EUO requests, and addressing flawed denials, legal counsel streamlines the recovery process for providers. Instead of spending hours on follow-up correspondence and rejected claims, providers gain time to focus on patient care while legal professionals challenge carrier overreach.
At Ursulova Law Offices, P.C., we have handled no-fault arbitration for nearly two decades. Our legal team has built persuasive strategies around the procedural habits and preferences of more than 130 arbitrators. This familiarity helps us frame arguments that resonate, and our strong record of post-arbitration appeals gives clients added confidence in even the most contested cases.
We understand how delayed payments impact medical operations, which is why we prioritize aggressive follow-ups and clear documentation strategies. Every case we handle receives focused attention from attorneys familiar with both the legal standards and the day-to-day realities of healthcare billing.
Everything You Need to Know About No-Fault Arbitration and Insurance Defense
Understanding Arbitration as the Primary Avenue for Resolution
No-fault arbitration is the preferred method for resolving medical reimbursement disputes in New York. It offers a faster, more controlled process compared to traditional litigation. Unlike courtroom trials, arbitration allows for focused hearings where the arbitrator’s background and prior rulings can be factored into case preparation. Our legal team studies each arbitrator’s past decisions to craft arguments that address their legal interpretation style and evidentiary expectations.
For every claim, we treat arbitration as inevitable—not optional. This means we build each submission with precision, making sure documentation, legal theories, and provider narratives all align. The result is a more persuasive presentation that anticipates pushback and directly addresses insurer defenses.
Challenging Denials Based on Policy Terms and Coverage Issues
Insurers often deny claims by pointing to policy limitations, retroactive cancellations, or policy exhaustion. These denials may appear legitimate on the surface, but our no-fault attorney team closely inspects supporting documents to expose procedural deficiencies. We examine how and when the cancellation was communicated, whether proper notice was issued, and whether the carrier followed state-mandated procedures.
In many cases, these reviews uncover inconsistencies that weaken the insurer’s position. Arbitrators are often persuaded by evidence that cancellation notices were untimely, ambiguous, or procedurally flawed—leading to favorable outcomes for our clients.
Handling Improper EUO and IME Requests
Examinations Under Oath (EUOs) and Independent Medical Examinations (IMEs) are often used to delay or avoid payment. Providers are routinely summoned for redundant interviews or last-minute exam scheduling that burdens clinical operations. We evaluate the legitimacy of these requests and respond accordingly.
If a demand is unreasonable, vague, or untimely, we raise objections that often result in withdrawal or retraction. When compliance is required, our no-fault lawyer ensures your rights are preserved, attends the EUO alongside you, and limits questions to those relevant to the dispute.
Identifying and Disputing Insurer Delay Tactics
Delay is among the most damaging tactics insurers use. Providers may wait months for reimbursement, only to be met with repetitive document requests or ambiguous denials. These stalling techniques disrupt revenue flow and add unnecessary administrative burdens.
We challenge these practices by invoking strict regulatory deadlines. Once a claim is submitted, insurers must respond within a specific time frame. If they fail to meet those requirements, we escalate the issue to arbitration, often with favorable results due to the delay itself constituting a procedural violation.
Tackling Coding and Billing Discrepancies
Even minor billing differences—such as a mismatch between a CPT code and diagnosis—can result in full claim denials. Carriers often seize on these small discrepancies to avoid responsibility. Our firm reviews coding details in advance, addresses formatting issues, and assists in constructing billing explanations that clarify intent and service necessity.
When needed, we involve qualified experts who provide sworn statements or testify during arbitration to validate the appropriateness of the services rendered and the accuracy of the coding.
We also work directly with billing departments to ensure that submissions are not just compliant but strategically constructed to address potential points of insurer resistance. This preventative approach helps reduce delays and avoids repetitive cycles of denial and resubmission.
Defending Against Recoupment Attempts and Refund Demands
Carriers may request refunds on previously paid claims months after disbursement, alleging that an error or new policy interpretation justifies recovery. These demands are not always legitimate and often conflict with established no-fault law. Our attorneys respond by demanding proof of fraud or misrepresentation—without which no recovery is allowed.
We have successfully blocked multiple insurer attempts to claw back payments by showing that their grounds lack legal standing or procedural support.
Legal Support for All Types of Providers
Our legal services are not limited by the size or scope of your medical practice. We represent solo providers as well as large medical facilities offering physical therapy, diagnostic services, orthopedics, and acupuncture. Whether your practice is located in Brighton Beach or Garden City, our no-fault attorney team understands how to present your documentation, address insurer objections, and secure timely payment for your services.
We bring a deep familiarity with how each insurer approaches claim evaluation and structure our legal arguments accordingly. This consistency in preparation allows us to deliver reliable outcomes for both new and long-standing clients across the healthcare spectrum.
Frequently Asked Questions
- What types of claims can a no-fault lawyer help recover?
A no-fault lawyer can assist with claims related to physical therapy, imaging, surgical aftercare, chiropractic treatments, acupuncture, orthopedics, and durable medical equipment. If it’s medically necessary and linked to an auto accident, legal support can improve your odds of recovery. - Do I need to attend every EUO requested by an insurer?
Not always. If the request is vague, repetitive, or procedurally flawed, your attorney can object and potentially prevent your attendance. When participation is necessary, legal counsel will accompany you to protect your interests. - What happens if an insurer delays payment without issuing a denial?
If an insurer doesn’t respond within the required timeframe, this delay may violate no-fault regulations. Legal action can be taken to enforce compliance, often resulting in interest penalties or arbitration awards in your favor. - Can I appeal an unfavorable arbitration award?
Yes. Awards can be appealed to a master arbitrator and, in some cases, through judicial review. Grounds for appeal include legal error, missed evidence, or procedural irregularities during the hearing. - How long does it take to resolve a no-fault arbitration claim?
Timelines vary, but most claims submitted through arbitration resolve within a few months. Claims that are well-prepared and legally sound tend to move through the process more efficiently, especially when handled by experienced attorneys.
Contact Ursulova Law Offices, P.C. to find out how our NY bankruptcy attorneys can help you today. Our offices are located in New York, Brighton Beach, Brooklyn and Garden City.
