John Sherman, Of Counsel to The Russell Friedman Law Group, LLP was recently successful in securing an $86,000+ recovery for a hospital that was denied payment by a No-Fault insurer.
As detailed in court documents, Mr. Sherman represented an acute care hospital that provided emergency room and hospital services to a man who suffered injuries in a motor vehicle accident. After seeking reimbursement of an outstanding bill, the hospital’s claim was denied by the insurer, which argued that there were insufficient benefits available to cover the claim.
Upon reviewing evidence and correspondence from the insurer, the arbitrator found that the No-Fault insurer’s exhaustion defense could not be sustained in the absence of any proof that it had sent the NF-11.
While the insurer (American Transit) appealed the award, it was ultimately upheld by the Master Arbitrator. As such, the hospital will be able to recover the $86,670.31 in No-Fault benefits.
Lincoln Medical & Mental Health Center v. American Transit Insurance Company, AAA Case No. 17-22-1264-0219 (Arbitrator Robyn McAllister, 4/29/2023), aff’d by Master Arbitrator Ancowitz, 99-22-1264-0219 (7/25/23). Read the full arbitration award here.
The Russell Friedman Law Group, LLP represents healthcare providers in matters related to No-Fault consulting, compliance, and collections, including the recovery of unpaid/underpaid No-Fault billing by insurance carriers in arbitration and litigation. To learn more about our services or to discuss a potential case, call (855) 465-4622 or contact us online.