A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL

Size: px
Start display at page:

Download "A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL"

Transcription

1 CASE NO. 18 Z A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z v. INS. CO. CLAIMS NO.: 2911P FARM FAMILY DRP NAME: John J. Fannan INSURANCE COMPANY NATURE OF DISPUTE: MEDICAL NECESSITY, PRE-CERTIFICATION AND AFFIDAVIT OF NO INSURANCE (Respondent) AWARD OF DISPUTE RESOLUTION PROFESSIONAL I, THE UNDERSIGNED DISPUTE RESOLUTION PROFESSIONAL (DRP), designated by the American Arbitration Association under the Rules for the Arbitration of No-Fault Disputes in the State of New Jersey, adopted pursuant to the 1998 New Jersey Automobile Insurance Cost Reduction Act as governed by N.J.S.A. 39:6A-5, et. seq., and, I have been duly sworn and have considered such proofs and allegations as were submitted by the Parties. The Award is DETERMINED as follows: Injured Person(s) hereinafter referred to as: The Claimant 1. Oral Hearings were held on: February 24, ALL PARTIES APPEARED at the oral hearing(s). NO ONE appeared telephonically. 3. Claims in the Demand for Arbitration WERE NOT amended at the oral hearing as permitted by the DRP (Amendments, if any, set forth below). STIPULATIONS were not made by the parties regarding the issues to be determined (Stipulations, if any, set forth below). 4. FINDINGS OF FACTS AND CONCLUSIONS OF LAW: I find the Claimant was injured as the result of an automobile accident which occurred on November 8, I further find that the Claimant was eligible to make claim for PIP benefits pursuant to the terms and conditions of a policy of automobile insurance issued by the respondent. The claimant came under the care of the Hamilton Chiropractic Center on November 11, 2002 complaining of headaches, neck pain, mid and low back pain, pain radiating down

2 CASE NO. 18 Z the right arm and right leg. The physical examination conducted by Dr. Beato revealed tenderness upon digital palpation of the C3-C4 spinous processes and deep and superficial muscle spasm, tenderness and muscle splinting of the anterior cervical paravertebral musculature bilaterally. The cervical range of motion was decreased with pain due to spasm. Also, the lumbar examination revealed spasm and tenderness upon palpation of paraspinal musculature at tenderness upon palpation of the L3-L4 spinous processes. Lumbar range of motion was similarly decreased. A series of orthopedic/neurologic tests administered produced positive results. Based upon the claimant s subjective complaints, and the results of the physical examination and orthopedic/neurologic testing, Dr. Beato formed the following diagnostic impression: Acute severe post-traumatic cervical sprain, acute severe post-traumatic lumbar sprain. He also noted that a disc bulge at L4-5 and L5-S1 was later confirmed by an MRI. The claimant was placed on a program of chiropractic treatment consisting of traction followed by chiropractic manipulative therapy and therapeutic massage. The patient continued to treat with Hamilton Chiropractic Center through February 21, It is the bill for treatments rendered by Hamilton Chiropractic Center during those dates of service ($3,189.26) which is open and is at issue in this arbitration. Also, during the course of his treatment with Dr. Beato, the patient was referred for evaluation in physical medicine and rehabilitation to the Regional Rehab Associates, which evaluation took place on January 20, Dr. Jaffe conducted a physical examination which confirmed the presence of tenderness to palpation in both the cervical and lumbosacral spines with muscle spasm and restricted ranges of motion. Dr. Jaffe recommended continued chiropractic treatment as well as therapeutic intervention including intersegmental traction, moist heat, manipulation and deep tissue massage. Dr. Jaffe also prescribed Fiurocet. It is this consultation with Regional Rehab Associates ($225.00) which is also open and unpaid and is a subject of this arbitration. Finally, on February 21, 2003, the claimant was referred by Dr. Beato to Capitol Open MRI for an MRI of the lumbar spine which was performed on that date. The bill of Capitol Open MRI ($925.00) is also open and unpaid and at issue. The respondent argues payment was initially denied because there was no listing of the claimant s name on the police report. However, it was subsequently discovered there was a second page to that police report which did in fact list the name of this claimant. Payment then was delayed because the claimant failed to submit a PIP Application. On January 31, 2003, a PIP Application was subsequently supplied. Additionally, the carrier denied payment because the claimant failed to supply an Affidavit of No Insurance. The respondent argues that three Affidavits of No Insurance had been sent to the claimant, none had been returned. Finally, the respondent indicates it denied payment because no medical provider had ever sought to obtain Pre-Certification for the treatments at issue. The following documents have been submitted for review and consideration:

3 CASE NO. 18 Z Demand for Arbitration; Medical Bills; Police report (with collision description narrative); PIP Application; Report of Dr. Beato; Report of Dr. Jaffe; MRI report. With respect to the issue of the failure of the claimant to provide an Affidavit of Insurance, I find the information provided on the Application for PIP Benefits sufficiently addresses the information sought to be obtained through the Affidavit of No Insurance. The claimant has made the averment that neither he nor any member of his household owned an automobile, that he was not the driver of the automobile but was a passenger therein and was not a member of an automobile owner s household. No evidence has been introduced which would suggest that the respondent had any basis for suspicion of any of those representations. Nor has any evidence been introduced that the respondent took any steps to obtain that information other than mailing requests for same to the claimant and/or the claimant s counsel. Where medical necessity is an issue, the claimant bears burden of proof to a preponderance of the evidence. Where there is a dispute, the burden rests on the claimant to establish that the services for which he seeks PIP Payment were reasonable, necessary and causally related to an automobile accident. Miltner v. Safeco Insurance Company of America, 175 N.J. Super 156 (Law Div. 1980). The necessity of medical treatment is a matter to be decided in the first instance by the claimant's treating physicians, and an objectively reasonable belief in the utility of a treatment or diagnostic method based on the credible and reliable evidence of it's medical value is enough to qualify the expense for PIP Purposes. Medical expenses have been considered necessary even if the services only provide temporary relief from symptoms and will neither cure nor repair a medical condition or problem. Miskofsky v. Ohio Casualty Insurance Company, 203 N.J. Super 400 (Law Div. 1984). The necessity of medical treatment is a matter to be decided in the first instance by the claimant's treating physicians, and an objectively reasonable belief in the utility of a treatment or diagnostic method based on the credible and reliable evidence of it's medical value is enough to qualify the expense for PIP purposes. Thermographic Diagnostics v. Allstate, 125 N.J. 491 (1991). While the fact that a treatment is only intended to provide relief from symptoms is not alone a reason to deny benefits, such treatment must still be reasonable and necessary. Palliative care is compensable under PIP when it is medically reasonable and necessary. Elkins v. New Jersey Manufacturers Insurance Co., 244 N.J. Super 695 (App. Div. 1990). Additionally, pursuant to Case Law developed in this State, where there is a conflict of testimony of medical experts, generally greater weight is to be given to the testimony of the treating physician. Mewes v. Union Building & Construction Company, 45 NJ Super 89 (App. Div. 1957); Biaco v. H. Baker Milk Company, 38 NJ Super 109 (App. Div. 1955); Abelit v. General Motors Corporation, 46 NJ Super 475 (App. Div. 1957).

4 CASE NO. 18 Z Medically Necessary is defined in NJAC 11:3-4.2 as medical treatment or diagnostic testing which is consistent with the clinically supported symptoms, diagnosis or indications of the injured person. That same section of the Administrative Code defines clinically supported as meaning that a health care provider prior to selecting, performing or ordering the administration of a treatment or diagnostic has (1) personally examined the patient to insure that the proper medical indications exist to justify ordering the treatment or tests; (2) physically examined the patient including making an assessment of any current and/or historical subjective complaints, observations, objective findings, neurologic indications and physical tests; (3) considered any and all previously performed tests that relate to the injury ;(4) recorded and documented these observations. The reports and records provided by Hamilton Chiropractic Center thoroughly document the presence of the patient s subjective complaints, as well as document the results of a physical examination and orthopedic/neurologic testing which provide objective corroboration for those complaints. The respondent offers no medical reports which would contradict the determination of Dr. Beato with respect to the medical necessity for the chiropractic treatment offered. I find the reports and records provided by the claimant have established to a preponderance of the evidence that the treatment provided by Hamilton Chiropractic Center from 11/11/02 through 2/21/03 was reasonable, medically necessary and for a condition or conditions causally related to the subject accident. I further find those reports and records also establish to a preponderance of the evidence that the consultation service of the Regional Rehab Associates requested by Dr. Beato was also reasonable, medically necessary and for a condition or conditions causally related to the subject accident. With respect to the claim of Capitol Open MRI, it is noted that the Administrative Code defines Medical Expense means the reasonable and necessary expenses for treatment or services rendered by a provider, including diagnostic services. NJAC 11: That same section of the Administrative Code defines diagnostic test as follows: A medical service or procedure intended to assist in establishing a medical, dental, physical therapy, chiropractic or psychological diagnosis, for the purpose of recommending or developing a course of treatment for the tested patient to be implemented by the treating practitioner or by the consultant. The MRI in this instance was performed on 2/21/03, the date of the claimant s last treatment with Hamilton Chiropractic Center. It can hardly be maintained then the diagnostic test (MRI) was for the purpose of recommending or developing a course of treatment for the tested patient to be implemented by the treating practitioner or by the consultant. That is a necessary requirement of the Administrative Code and one which I found has not been met here. Therefore, the bill of Capitol Open MRI is denied inasmuch as the MRI which was the subject of that bill has not been shown to be reasonable, medically necessary or prescribed in accordance with the New Jersey Administrative Code. In applying the Fee Schedule to the bills of Hamilton Chiropractic Center and Regional Rehab Associates, I find the eligible charge of Hamilton Chiropractic Center to be

5 CASE NO. 18 Z $2, and that of Regional Rehab Associates to be $ However, I find that no evidence has been introduced to indicate the treatments and consultation were subject of Pre-Certification requests, as is required in NJAC 11:3-4.8 for treatment rendered after the initial 10-day period immediately following the accident. Therefore, I find the treatment from Hamilton Chiropractic Center from 11/11/02-11/18/02 is reimbursable at 100% of the eligible charges or $ The treatment from 11/19/02 2/21/03, which produces an eligible charge of $2,048.00, is subject to application of a 50% additional copayment penalty for failure to pre-certify and is reimbursable at the amount of $1, Therefore, the bill of Hamilton Chiropractic Center is awarded in the amount of $1, Similarly, I find a Fee Scheduled amount for the bill of Regional Rehab Associates to be $ This eligible charge is subject to a 50% additional co-payment penalty for failure to properly pre-certify same and therefore the bill of Regional Rehab Associates is awarded in the amount of $ Inasmuch as no calculation of interest has been provided, the claim for interest is deemed to have been waived. I further find the claimant was successful and is entitled to an award of counsel fees. Counsel for the claimant has submitted no Certification of Services; however a review of the submissions made in conjunction with this claim lead me to find that an award of counsel fees in the amount of $ is consonant with the amount at issue herein and is consistent with the requisites of RPC 1.5 as well as consistent with the degree of effort, expertise and experience required for a successful prosecution of this claim. I also award costs in the amount of $ I further find the award of counsel fees in that amount to be consistent with the mandates of the Court in Enright v. Lubow, 215 NJ Super 306, (App. Div.), cert. Denied 108 NJ 193 (1987) as well as of Scullion v. State Farm, 345 N.J. Super 431 (App. Div. 2001). This matter was the subject of an oral hearing conducted on February 24, The hearing was held open to afford the parties the opportunity to make additional submission, including the opportunity for claimant s counsel to submit a Certification of Services, which was not done. The hearing was declared closed of March 15, MEDICAL EXPENSE BENEFITS: Awarded in part/denied in part Provider Amount Claimed Amount Awarded Payable to Hamilton Chiro Capitol Open MRI Regional Rehab Assoc. $ $ $ $1, $ Hamilton Chiro Capitol Open MRI Regional Rehab Assoc. Explanations of the application of the medical fee schedule, deductibles, co-payments, or other particular calculations of Amounts Awarded, are set forth below.

6 CASE NO. 18 Z INCOME CONTINUATION BENEFITS: Not in Issue 7. ESSENTIAL SERVICES BENEFITS: Not in Issue 8. DEATH BENEFITS: Not in Issue 9. FUNERAL EXPENSE BENEFITS: Not in Issue 10. I find that the CLAIMANT did prevail, and I award the following COSTS/ATTORNEYS FEES under N.J.S.A. 39:6A-5.2 and INTEREST under N.J.S.A. 39:6A-5h. (A) Other COSTS as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $ (B) ATTORNEYS FEES as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $ (C) INTEREST is as follows: Waived. This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. April 22, 2004 Date John J. Fannan, Esq.

Award of Dispute Resolution Professional. Hearing Information

Award of Dispute Resolution Professional. Hearing Information In the Matter of the Arbitration between Allied PT & Acupuncture a/s/o V.B. CLAIMANT(s), Forthright File No: NJ1012001364788 Insurance Claim File No: NJP66574 Claimant Counsel: Pacifico & Lawrence v. Claimant

More information

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL CASE NO. 18 Z 600 10126 02 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 10126 02 v.

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between JERSEY REHAB A/S/O C.R. CLAIMANT(s), Forthright File No: NJ1203001435098 Insurance Claim File No: ALE84350 Claimant Counsel: Melvin D. Marx, P.A. v. Claimant Attorney

More information

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL CASE NO. 18 Z 600 01641 03 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 01641 03 v.

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Hudson Pain Management, Osteopathic Medicine a/s/o C. B. CLAIMANT(s), Forum File No: NJ0904001256220 Insurance Claim File No: 254801049148 v. Claimant Attorney

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Objective Diagnostic & Rehab Services a/s/o V.K. CLAIMANT(s), Forthright File No: NJ1003001314411 Insurance Claim File No: 58993 Claimant Counsel: Law Offices of

More information

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL

A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL CASE NO. 18 Z 600 08077 03 2 A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z 600 08077 03 v.

More information

Award of Dispute Resolution Professional. In Person Proceeding Information

Award of Dispute Resolution Professional. In Person Proceeding Information In the Matter of the Arbitration between BACK PAIN, P.C. A/S/O JC CLAIMANT(s), Forthright File No: NJ1104001382836 Proceeding Type: In Person Insurance Claim File No: 1013647 Claimant Counsel: The Law

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Neurology & Pain Treatment Center a/s/o J.A. CLAIMANT(s), Forthright File No: NJ1108001403811 Insurance Claim File No: NJP86737 Claimant Counsel: Law Office of

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between North Jersey Rehabilitation Center a/s/o Y.L. CLAIMANT(s), Forthright File No: NJ0903001250685 Insurance Claim File No: 040900064409-003 Claimant Counsel: Joseph

More information

Award of Dispute Resolution Professional. Hearing Information

Award of Dispute Resolution Professional. Hearing Information In the Matter of the Arbitration between Xcalibur Chiropractic a/s/o M.P. CLAIMANT(s), Forthright File No: NJ1111001414166 Insurance Claim File No: NJP87566 Claimant Counsel: Console & Hollawell v. Claimant

More information

In the Matter of the Arbitration between

In the Matter of the Arbitration between In the Matter of the Arbitration between Advanced Spine Surgery Center a/s/o Magdalena Villacis CLAIMANT(s), Forthright File No: NJ1409001581707 Proceeding Type: In Person Insurance Claim File No: 20951803

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Dr. Arthur C. Rothman MD a/s/o JMI CLAIMANT(s), Forthright File No: NJ0909001283720 Insurance Claim File No: 0285625840101018 Claimant Counsel: Law Offices of Thomas

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Atlantic Orthopaedic Associates a/s/o M.C. CLAIMANT(s), Forthright File No: NJ1010001354284 Insurance Claim File No: 0267652480101027 Claimant Counsel: Law Offices

More information

CARE PATHS/DECISION POINT REVIEW

CARE PATHS/DECISION POINT REVIEW Personal Service Insurance Company PO Box 3001 Plymouth Meeting, PA 19462 Ph: 610.832.4940 Fax: 610.832.2138 Toll Free: 800.954.2442 Date (##/##/####) Physician Name Street Address City, State, Zip Claimant:

More information

IMPORTANT NOTICE. Decision Point Review & Pre-Certification Requirements INTRODUCTION

IMPORTANT NOTICE. Decision Point Review & Pre-Certification Requirements INTRODUCTION IMPORTANT NOTICE Decision Point Review & Pre-Certification Requirements INTRODUCTION At GEICO, we understand that when you purchase an automobile insurance policy, you are buying protection and peace of

More information

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS

PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS DECISION POINT REVIEW: Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and

More information

Our Customer: Claim Number: Date of Loss: Dear

Our Customer: Claim Number: Date of Loss: Dear MetLife Auto & Home Our Customer: Claim Number: Date of Loss: Dear Personal Injury Protection (PIP) is the portion of the auto policy that provides coverage for medical expenses. These medical expenses

More information

STATE OF NEW JERSEY DEPARTMENT OF LABOR DIVISION OF WORKERS COMPENSATION ATLANTIC CITY DISTRICT

STATE OF NEW JERSEY DEPARTMENT OF LABOR DIVISION OF WORKERS COMPENSATION ATLANTIC CITY DISTRICT STATE OF NEW JERSEY DEPARTMENT OF LABOR DIVISION OF WORKERS COMPENSATION ATLANTIC CITY DISTRICT CAPE REGIONAL MEDICAL CENTER : (Jeffrey Davis) Petitioner, : CLAIM PETITION NO. 2012-28812 v. : RESERVED

More information

FREQUENTLY ASKED DECISION POINT REVIEW/PRE-CERTIFICATION QUESTIONS

FREQUENTLY ASKED DECISION POINT REVIEW/PRE-CERTIFICATION QUESTIONS FREQUENTLY ASKED DECISION POINT REVIEW/PRE-CERTIFICATION QUESTIONS INTRODUCTION At 21st Century Centennial Insurance Company, we understand that when you purchase an automobile insurance policy, you are

More information

PERSONAL INJURY PROTECTION DISPUTE RESOLUTION. The purpose of this subchapter is to establish procedures for the resolution of disputes

PERSONAL INJURY PROTECTION DISPUTE RESOLUTION. The purpose of this subchapter is to establish procedures for the resolution of disputes SUBCHAPTER 5. PERSONAL INJURY PROTECTION DISPUTE RESOLUTION 11:3-5.1 Purpose and scope (a) The purpose of this subchapter is to establish procedures for the resolution of disputes concerning the payment

More information

The effective date of the plan is the date approved by the Department of Banking and Insurance.

The effective date of the plan is the date approved by the Department of Banking and Insurance. Decision Point Review/Pre-Certification Plan for: New Jersey Skylands Management, LLC servicing: New Jersey Skylands Insurance Association (NAIC# 11454) New Jersey Skylands Insurance Company (NAIC# 11453)

More information

New Jersey Regional Claims PO Box 5483 Mount Laurel, NJ 08054 Phone : 1-800-451-5982 Fax : 856-235-6232. Date (##/##/####)

New Jersey Regional Claims PO Box 5483 Mount Laurel, NJ 08054 Phone : 1-800-451-5982 Fax : 856-235-6232. Date (##/##/####) New Jersey Regional Claims PO Box 5483 Mount Laurel, NJ 08054 Phone : 1-800-451-5982 Fax : 856-235-6232 Date (##/##/####) Physician Name Street Address City, State, Zip Claimant: Claim Number: Medlogix

More information

IMPORTANT INFORMATION ABOUT YOUR PERSONAL INJURY PROTECTION COVERAGE (ALSO KNOWN AS NO-FAULT MEDICAL COVERAGE)

IMPORTANT INFORMATION ABOUT YOUR PERSONAL INJURY PROTECTION COVERAGE (ALSO KNOWN AS NO-FAULT MEDICAL COVERAGE) IMPORTANT INFORMATION ABOUT YOUR PERSONAL INJURY PROTECTION COVERAGE (ALSO KNOWN AS NO-FAULT MEDICAL COVERAGE) The New Jersey Automobile Insurance Cost Reduction Act (AICRA) introduced changes to how auto

More information

Overview of the Provisions of the NJ Automobile Insurance Cost Reduction Act

Overview of the Provisions of the NJ Automobile Insurance Cost Reduction Act Overview of the Provisions of the NJ Automobile Insurance Cost Reduction Act has requested that CorVel Corporation work with you and your physician to assure that you receive all medically

More information

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE:

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Notice of Independent Review Decision DATE OF REVIEW: 08/15/08 IRO CASE #: NAME: DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Determine the appropriateness of the previously denied request for physical

More information

Company Name: Claim Number: Loss Date: Policy Holder: Premier Prizm Acct No.: Injured Party:

Company Name: Claim Number: Loss Date: Policy Holder: Premier Prizm Acct No.: Injured Party: PO Box 9515 Fredericksburg, VA 22403-9515 Mail Date: Date Loss Reported to GEICO:!!!### Company Name: Claim Number: Loss Date: Policy Holder: Premier Prizm Acct No.: Injured Party: Personal Injury Protection

More information

MetLife Auto & Home. Decision Point Review and Pre-certification Plan Q & A

MetLife Auto & Home. Decision Point Review and Pre-certification Plan Q & A MetLife Auto & Home INTRODUCTION Decision Point Review and Pre-certification Plan Q & A At MetLife Auto & Home, we understand that when you purchase an automobile insurance policy, you are buying protection

More information

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY PAC 3606 TL (Ed. 1/06) Twin Lights Decision Point Review Plan DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY The following provisions apply in the event that you (or anyone

More information

Award of Dispute Resolution Professional

Award of Dispute Resolution Professional In the Matter of the Arbitration between Neurosurgical Spine Specialists of NJ A/S/O D.O. CLAIMANT(s), Forthright File No: NJ1102001370534 Insurance Claim File No: 0336333740101035 Claimant Counsel: Law

More information

ENCOMPASS INSURANCE COMPANY OF NEW JERSEY DECISION POINT & PRECERTIFICATION PLAN

ENCOMPASS INSURANCE COMPANY OF NEW JERSEY DECISION POINT & PRECERTIFICATION PLAN ENCOMPASS INSURANCE COMPANY OF NEW JERSEY DECISION POINT & PRECERTIFICATION PLAN DECISION POINT REVIEW: Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and Insurance has published standard

More information

American Commerce Insurance Company

American Commerce Insurance Company American Commerce Insurance Company INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDERS Dear Insured and/or /Eligible Injured Person/Medical Provider: Please read this letter carefully because it

More information

10 Woodbridge Center Drive * PO Box 5038* Woodbridge, NJ 07095

10 Woodbridge Center Drive * PO Box 5038* Woodbridge, NJ 07095 10 Woodbridge Center Drive * PO Box 5038* Woodbridge, NJ 07095 Date Name Address RE: CLAIMANT: CLAIM#: INSURANCE CO: CAMDEN FIRE INSURANCE ASSOCIATION CISI#: DOL: Dear : Please read this letter carefully

More information

DECISION POINT REVIEW

DECISION POINT REVIEW ALLSTATE NEW JERSEY INSURANCE COMPANY/ALLSTATE NEW JERSEY PROPERTY AND CASUALTY INSURANCE COMPANY DECISION POINT REVIEW PLAN INCLUSIVE OF PRE-CERTIFICATION REQUIREMENT DECISION POINT REVIEW Pursuant to

More information

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION DONALD BRYAN SMITHHISLER Claimant VS. LIFE CARE CENTERS AMERICA, INC. Respondent Docket No. 1,014,349 AND OLD REPUBLIC INSURANCE

More information

GEICO General Insurance Company

GEICO General Insurance Company GEICO General Insurance Company Buffalo/New Jersey Claims, PO BOX 9515 Fredericksburg, VA 22403-9515 Date Date Loss Reported to GEICO: Company Name: Claim Number: Loss Date: Policyholder: Policy Number:

More information

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY PO Box 920 Lincroft, NJ 07738 Underwritten by Teachers Auto Insurance Company of New Jersey TIP 3606 (Ed. 3/12) Decision Point Review Plan DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER

More information

New Jersey No-Fault PIP Arbitration Rules (2013)

New Jersey No-Fault PIP Arbitration Rules (2013) New Jersey No-Fault PIP Arbitration Rules (2013) Amended March 1, 2013 ADMINISTERED BY FORTHRIGHT New Jersey No-Fault PIP Arbitration Rules 2 PART I RULES OF GENERAL APPLICATION...5 1. Scope of Rules...5

More information

COMPENSATION ORDER TIMOTHY BURROUGHS, ) Claimant, ) ) AHD No. 06-094 v. ) OWC No. 597835 J & J MAINTENANCE, INC., ) and ) AIG CLAIMS SERVICES, )

COMPENSATION ORDER TIMOTHY BURROUGHS, ) Claimant, ) ) AHD No. 06-094 v. ) OWC No. 597835 J & J MAINTENANCE, INC., ) and ) AIG CLAIMS SERVICES, ) IN THE MATTER OF, TIMOTHY BURROUGHS, Claimant, AHD No. 06-094 v. OWC No. 597835 J & J MAINTENANCE, INC., and AIG CLAIMS SERVICES, Employer/Carrier. Appearances REBEKAH ARCH MILLER, ESQUIRE For the Claimant

More information

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851 Dear Insured: Please read this letter carefully because it provides specific information concerning how a medical claim under personal injury protection coverage will be handled, including specific requirements

More information

PIP Claim Information Basic Policy

PIP Claim Information Basic Policy PIP Claim Information Basic Policy We understand this may be a difficult and confusing experience and we wish to assist you in any way we can. We hope the following information will help explain the claims

More information

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review OFFICE OF INSURANCE REGULATION Property and Casualty Product Review NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER THE FLORIDA MOTOR VEHICLE

More information

00/00/00 CARE PATHS/DECISION POINT REVIEW

00/00/00 CARE PATHS/DECISION POINT REVIEW 00/00/00 FIRST-NAME MI LAST-NAME BUSINESS-NAME ST-NO STREET UNIT-NO CITY, STATE ZIP Insured: INSD-FIRST-NAME INSD-MI INSD-LAST-NAME Claim No: CLAIM-NO DIV-EX Date of Loss: MO-LOSS/DAY-LOSS/YR Dear DEAR-NAME:

More information

Date. Name Name Address City, State Zip ATTN: PATIENT NAME: CLAIM NUMBER: DATE OF LOSS: Dear Doctor:

Date. Name Name Address City, State Zip ATTN: PATIENT NAME: CLAIM NUMBER: DATE OF LOSS: Dear Doctor: Date Name Name Address City, State Zip ATTN: PATIENT NAME: CLAIM NUMBER: DATE OF LOSS: Dear Doctor: Personal Injury Protection (PIP) is the portion of the auto policy that provides coverage for medical

More information

INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDERS Sent on Concentra Integrated Services Letter Head

INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDERS Sent on Concentra Integrated Services Letter Head INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDERS Sent on Concentra Integrated Services Letter Head Dear Insured and/or Eligible Injured Person/Medical Provider: Please read this letter carefully

More information

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851 Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851 Dear Insured: Personal Injury Protection (PIP) is the portion of the auto policy that provides coverage for medical expenses. These

More information

NEW JERSEY PERSONAL INJURY PROTECTION DECISION POINT REVIEW AND PRE-CERTIFICATION

NEW JERSEY PERSONAL INJURY PROTECTION DECISION POINT REVIEW AND PRE-CERTIFICATION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEW JERSEY PERSONAL INJURY PROTECTION DECISION POINT REVIEW AND PRE-CERTIFICATION This endorsement modifies insurance provided under the following:

More information

State Farm Indemnity Company State Farm Guaranty Insurance Company Personal Injury Protection Benefits New Jersey Decision Point Review Plan

State Farm Indemnity Company State Farm Guaranty Insurance Company Personal Injury Protection Benefits New Jersey Decision Point Review Plan State Farm Indemnity Company State Farm Guaranty Insurance Company Personal Injury Protection Benefits New Jersey Decision Point Review Plan Pursuant to N.J.A.C. 11:3-4.7, State Farm submits the following

More information

Gilbert Varela, M.D., Inc 5232 E. Beverly Boulevard Los Angeles, California 90022 Phone: (323) 724-6911 Fax: (323) 724-6915

Gilbert Varela, M.D., Inc 5232 E. Beverly Boulevard Los Angeles, California 90022 Phone: (323) 724-6911 Fax: (323) 724-6915 Gilbert Varela, M.D., Inc 5232 E. Beverly Boulevard Los Angeles, California 90022 Phone: (323) 724-6911 Fax: (323) 724-6915 September 10, 2007 Law offices of xxxxxxxxx Santa Monica, CA 90405 REGARDING:

More information

DECISION POINT REVIEW PLAN REQUIREMENTS IMPORTANT INFORMATION

DECISION POINT REVIEW PLAN REQUIREMENTS IMPORTANT INFORMATION NJM Insurance 301 Sullivan Way, West Trenton, NJ 08628 Group 609-883-1300 / www.njm.com DECISION POINT REVIEW PLAN REQUIREMENTS IMPORTANT INFORMATION For Licensed Health Care Providers About No-Fault Medical

More information

CHUBB GROUP OF INSURANCE COMPANIES

CHUBB GROUP OF INSURANCE COMPANIES CHUBB GROUP OF INSURANCE COMPANIES Dear Insured, Attached please find an informational letter which is being sent to your treating provider outlining the processes and procedures for Precertification and

More information

For all of the reasons set forth, we enter the following: Herd Chiropractic v. State Farm

For all of the reasons set forth, we enter the following: Herd Chiropractic v. State Farm 180 DAUPHIN COUNTY REPORTS [124 Dauph. Proposed Distribution, Exhibit F; Answer of CHFI to Petition for Relief, para. 17) Therefore, CHFI is not a health care provider, the type to which the testator intended

More information

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER United States Department of Labor G.M., Appellant and DEPARTMENT OF EDUCATION, OFFICE FOR CIVIL RIGHTS, Kansas City, MO, Employer Appearances: Appellant, pro se Office of Solicitor, for the Director Docket

More information

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE 11:3-29.1 Purpose and scope (a) This subchapter implements the provisions

More information

CURE DECISION POINT REVIEW PLAN (DPRP) DISCLOSURE NOTICE Page 1 of 5

CURE DECISION POINT REVIEW PLAN (DPRP) DISCLOSURE NOTICE Page 1 of 5 CURE DECISION POINT REVIEW PLAN (DPRP) DISCLOSURE NOTICE Page 1 of 5 How To Comply with the DPRP Requirements Of Your CURE Policy The 'Automobile Insurance Cost Reduction Act' was signed into law on May

More information

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review

OFFICE OF INSURANCE REGULATION Property and Casualty Product Review OFFICE OF INSURANCE REGULATION Property and Casualty Product Review NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER THE FLORIDA MOTOR VEHICLE

More information

The Law Office of Jeffrey Randolph, LLC Admitted in NJ & NY Admitted in U.S. Court of Appeals -Third Circuit Admitted in U.S. Court of Federal Claims

The Law Office of Jeffrey Randolph, LLC Admitted in NJ & NY Admitted in U.S. Court of Appeals -Third Circuit Admitted in U.S. Court of Federal Claims The Law Office of Jeffrey Randolph, LLC Admitted in NJ & NY Admitted in U.S. Court of Appeals -Third Circuit Admitted in U.S. Court of Federal Claims New Jersey Office: New York Office: 139 Harristown

More information

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER United States Department of Labor V.L., Appellant and DEPARTMENT OF JUSTICE, U.S. PROBATION DEPARTMENT, New York City, NY, Employer Appearances: Alan J. Shapiro, Esq., for the appellant Office of Solicitor,

More information

DECISION POINT REVIEW PLAN REQUIREMENTS

DECISION POINT REVIEW PLAN REQUIREMENTS NJM Insurance 301 Sullivan Way, West Trenton, NJ 08628 Group 609-883-1300 / www.njm.com DECISION POINT REVIEW PLAN REQUIREMENTS IMPORTANT INFORMATION ABOUT YOUR NO-FAULT MEDICAL COVERAGE For NJM Insurance

More information

The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance

The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance The Schlitt Law Firm A Consumer Guide to New York No-Fault Auto Insurance The Schlitt Law Firm 79 Wall Street, Huntington, NY 11743 www.schlittlaw.com 631.425.9775 A Consumer Guide An Explanation of New

More information

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY

DECISION POINT REVIEW AND PRE-CERTIFICATION REQUIREMENTS UNDER YOUR AUTO POLICY PALISADES SAFETY AND INSURANCE ASSOCIATION PALISADES INSURANCE COMPANY PALISADES SAFETY AND INSURANCE MANAGEMENT CORPORATION, ATTORNEY-IN-FACT PO Box 617 Two Connell Drive Berkeley Heights, NJ 07922 Tel

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691. TERRY FOSTER, Employee. TYSON SALES & DISTRIBUTION, Self-Insured Employer

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691. TERRY FOSTER, Employee. TYSON SALES & DISTRIBUTION, Self-Insured Employer BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691 TERRY FOSTER, Employee TYSON SALES & DISTRIBUTION, Self-Insured Employer CLAIMANT RESPONDENT OPINION FILED NOVEMBER 20, 2013 Hearing

More information

FLORIDA PERSONAL INJURY PROTECTION

FLORIDA PERSONAL INJURY PROTECTION POLICY NUMBER: COMMERCIAL AUTO CA 22 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA PERSONAL INJURY PROTECTION For a covered "auto" licensed or principally garaged in,

More information

New York State Department of Financial Services

New York State Department of Financial Services New York State Department of Financial Services Home Regulation 68 index page In order to assist you in viewing Regulation 68 in its most current form, this webpage has incorporated the text of the 1st

More information

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION RONALD L. MARTENS Claimant VS. BRULEZ FOUNDATION, INC. Respondent Docket No. 1,019,265 AND COMMERCE & INDUSTRY INS. CO. Insurance

More information

Hortica Insurance #1 Horticultural Lane PO Box 428 Edwardsville IL 62025 1-800-851-7740 Fax 1-800-632-4445

Hortica Insurance #1 Horticultural Lane PO Box 428 Edwardsville IL 62025 1-800-851-7740 Fax 1-800-632-4445 Hortica Insurance #1 Horticultural Lane PO Box 428 Edwardsville IL 62025 1-800-851-7740 Fax 1-800-632-4445 Claimant: Claim Number: Medlogix ID #: Date of Accident: Insured: Dear Provider: This letter is

More information

NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL

NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL Appellant: [X] (Employer) Participants entitled to respond to this appeal: [X] (Worker) and The Workers Compensation Board of Nova Scotia (Board) APPEAL

More information

American Commerce Insurance Company

American Commerce Insurance Company American Commerce Insurance Company Decision Point Review Plan And Pre-certification Requirements DECISION POINT REVIEW Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and Insurance has

More information

Understanding Florida s PIP Laws

Understanding Florida s PIP Laws Understanding Florida s PIP Laws Bacen & Jordan, P.A. Renee Jordan, Esq. 4801 South University Drive Suite 3100 Davie, FL 33328 (954) 961-5511 rjordan@bacenjordan.com PIP = No Fault!! No Fault are first

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G103629 SHIKITA WRIGHT, EMPLOYEE OPINION FILED JULY 10, 2013

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G103629 SHIKITA WRIGHT, EMPLOYEE OPINION FILED JULY 10, 2013 BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. G103629 SHIKITA WRIGHT, EMPLOYEE ARKANSAS DEPARTMENT OF HUMAN SERVICES, EMPLOYER PUBLIC EMPLOYEE CLAIMS DIVISION, INSURANCE CARRIER CLAIMANT

More information

MEMORANDUM. October 1,2008. Emergent Medical Care, Contact Person, Enforcement and UEF Rule Proposals

MEMORANDUM. October 1,2008. Emergent Medical Care, Contact Person, Enforcement and UEF Rule Proposals DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT JON S. CORZINE PO BOX 381 DAVID J. SOCOLOW Governor TRENTON, NEW JERSEY 08625-0381 Commissioner MEMORANDUM October 1,2008 To: All Judges, Attorneys and Case

More information

TITLE 11. INSURANCE CHAPTER 3. AUTOMOBILE INSURANCE SUBCHAPTER 5. PERSONAL INJURY PROTECTION DISPUTE RESOLUTION

TITLE 11. INSURANCE CHAPTER 3. AUTOMOBILE INSURANCE SUBCHAPTER 5. PERSONAL INJURY PROTECTION DISPUTE RESOLUTION TITLE 11. INSURANCE CHAPTER 3. AUTOMOBILE INSURANCE SUBCHAPTER 5. PERSONAL INJURY PROTECTION DISPUTE RESOLUTION 11:3-5.1 Purpose and scope (a) The purpose of this subchapter is to establish procedures

More information

PRE-CERTIFICATION AND DECISION POINT REVIEW PLAN

PRE-CERTIFICATION AND DECISION POINT REVIEW PLAN PRE-CERTIFICATION AND DECISION POINT REVIEW PLAN The New Jersey Department of Banking and Insurance has published standard courses of treatment, identified as Care Paths, for soft tissue injuries of the

More information

INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDER/ATTORNEY

INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDER/ATTORNEY 685 Highway 202/206, Suite 301 P.O. Box 5919 Bridgewater, NJ 08807 (908) 243-1800 Toll free 1-800-987-2032 Fax 1-877-397-5868 INITIAL INFORMATION LETTER TO INSURED/CLAIMANT/PROVIDER/ATTORNEY «Date «PersonName_To»

More information

STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 ' ' ' ' ' ' ' ' I. Background Facts

STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 ' ' ' ' ' ' ' ' I. Background Facts HIGHPOINT PHARMACY, Petitioner V. STATE OFFICE OF ADMINISTRATIVE HEARINGS 300 West 15th Street, Suite 502 Austin, Texas 78701 SENTRY INSURANCE, A MUTUAL COMPANY Respondent DOCKET NO. 453-03-2098.M5 [MDR

More information

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NUMBER F205928 DOUGLAS EUGENE WHIPKEY, EMPLOYEE CLAIMANT XPRESS BOATS, EMPLOYER RESPONDENT CONTINENTAL CASUALTY CO., INSURANCE CARRIER RESPONDENT

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G405820. LINDA BECKER, Employee. GOODWILL INDUSTRIES, Employer

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G405820. LINDA BECKER, Employee. GOODWILL INDUSTRIES, Employer BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G405820 LINDA BECKER, Employee GOODWILL INDUSTRIES, Employer RISK MANAGEMENT RESOURCES, Carrier CLAIMANT RESPONDENT RESPONDENT OPINION FILED

More information

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION MARION A. DAVIS ) Claimant ) VS. ) ) Docket No. 216,570 CONSPEC MARKETING & MANUFACTURING CO. ) Respondent ) AND ) ) UNITED STATES

More information

Employees Compensation Appeals Board

Employees Compensation Appeals Board U. S. DEPARTMENT OF LABOR Employees Compensation Appeals Board In the Matter of DEBORAH R. EVANS and U.S. POSTAL SERVICE, POST OFFICE, Orlando, FL Docket No. 02-1888; Submitted on the Record; Issued December

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F608015. AMANDA VOLKMANN, Employee. SONIC DRIVE-IN, Employer

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F608015. AMANDA VOLKMANN, Employee. SONIC DRIVE-IN, Employer BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F608015 AMANDA VOLKMANN, Employee SONIC DRIVE-IN, Employer FARMERS INSURANCE EXCHANGE, Carrier CLAIMANT RESPONDENT RESPONDENT OPINION FILED

More information

UNIVERSAL UNDERWRITERS INSURANCE COMPANY

UNIVERSAL UNDERWRITERS INSURANCE COMPANY UNIVERSAL UNDERWRITERS INSURANCE COMPANY Decision Point Review Plan And Pre-certification Requirements DECISION POINT REVIEW Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and Insurance

More information

COMMONWEALTH OF MASSACHUSETTS APPELLATE DIVISION OF THE DISTRICT COURT DEPARTMENT NORTHERN DISTRICT ADVANCED SPINE CENTERS, INC. 1

COMMONWEALTH OF MASSACHUSETTS APPELLATE DIVISION OF THE DISTRICT COURT DEPARTMENT NORTHERN DISTRICT ADVANCED SPINE CENTERS, INC. 1 COMMONWEALTH OF MASSACHUSETTS APPELLATE DIVISION OF THE DISTRICT COURT DEPARTMENT NORTHERN DISTRICT ADVANCED SPINE CENTERS, INC. 1 V. ARBELLA MUTUAL INSURANCE COMPANY NO. 15-ADMS-10021 In the LOWELL DIVISION:

More information

HOUSE BILL 119 PERSONAL INJURY PROTECTION 2012

HOUSE BILL 119 PERSONAL INJURY PROTECTION 2012 HOUSE BILL 119 PERSONAL INJURY PROTECTION 2012 Eric S. Rice, Esq. CINCINNATI, OH COLUMBUS, OH DETROIT, MI FT. MITCHELL, KY ORLANDO, FL SARASOTA, FL www.smithrolfes.com Brief Synopsis Under the bill, to

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F311984. CHARLES MARTIN, Employee. VAN BUREN PIPE CORPORATION, Employer

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F311984. CHARLES MARTIN, Employee. VAN BUREN PIPE CORPORATION, Employer BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F311984 CHARLES MARTIN, Employee VAN BUREN PIPE CORPORATION, Employer CONSTITUTION STATE SERVICE COMPANY, Carrier CLAIMANT RESPONDENT RESPONDENT

More information

DECISION NUMBER 749 / 94 SUMMARY

DECISION NUMBER 749 / 94 SUMMARY DECISION NUMBER 749 / 94 SUMMARY The worker suffered a whiplash injury in a compensable motor vehicle accident in May 1991. The worker appealed a decision of the Hearings Officer denying entitlement when

More information

L. R. v. Fletcher Allen Health Care (January 4, 2007) STATE OF VERMONT DEPARTMENT OF LABOR

L. R. v. Fletcher Allen Health Care (January 4, 2007) STATE OF VERMONT DEPARTMENT OF LABOR L. R. v. Fletcher Allen Health Care (January 4, 2007) STATE OF VERMONT DEPARTMENT OF LABOR L. R. Opinion No. 57-06WC By: Margaret A. Mangan v. Hearing Officer Fletcher Allen Health Care For: Patricia Moulton

More information

Workers Compensation Mandatory Attorney Fees

Workers Compensation Mandatory Attorney Fees STATE OF NEW JERSEY NEW JERSEY LAW REVISION COMMISSION Draft Tentative Report Relating to November 7, 2011 This draft tentative report is distributed to advise interested persons of the Commission's tentative

More information

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER United States Department of Labor D.M., Appellant and DEPARTMENT OF THE AIR FORCE, WURTSMITH AIR FORCE BASE, MI, Employer Appearances: Alan J. Shapiro, Esq., for the appellant Office of Solicitor, for

More information

SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT

SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT GREG STURTZ, HF No. 277, 2000/01 Claimant, v. DECISION YOUNKERS, INC., Employer, and LIBERTY MUTUAL INSURANCE CO., Insurer. This is a workers

More information

SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT. MARK DENNIS MCQUAY HF No. 137, 2004/05

SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT. MARK DENNIS MCQUAY HF No. 137, 2004/05 SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT MARK DENNIS MCQUAY HF No. 137, 2004/05 Claimant, v. DECISION FISCHER FURNITURE, and ACUITY, Employer, Insurer. This is a workers compensation

More information

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER

United States Department of Labor Employees Compensation Appeals Board DECISION AND ORDER United States Department of Labor T.M., Appellant and DEPARTMENT OF HOMELAND SECURITY, IMMIGRATION & CUSTOMS ENFORCEMENT, New York, NY, Employer Appearances: Thomas S. Harkins, Esq., for the appellant

More information

13.12.3.1 ISSUING AGENCY: New Mexico Public Regulation Commission Insurance Division. [7/1/97; 13.12.3.1 NMAC - Rn & A, 13 NMAC 12.3.

13.12.3.1 ISSUING AGENCY: New Mexico Public Regulation Commission Insurance Division. [7/1/97; 13.12.3.1 NMAC - Rn & A, 13 NMAC 12.3. TITLE 13 CHAPTER 12 PART 3 INSURANCE MOTOR VEHICLE INSURANCE UNINSURED AND UNKNOWN MOTORISTS COVERAGE 13.12.3.1 ISSUING AGENCY: New Mexico Public Regulation Commission Insurance Division. [7/1/97; 13.12.3.1

More information

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F610657 ORDER AND OPINION FILED APRIL 24, 2007

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F610657 ORDER AND OPINION FILED APRIL 24, 2007 BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F610657 SHERRY ALLEN BIRCH TREE COMMUNITIES, INC. INSURANCE COMPANY - STATE OF PENNSYLVANIA CLAIMANT RESPONDENT EMPLOYER RESPONDENT CARRIER

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G011127 SHARON MCCULLER, EMPLOYEE OPINION FILED DECEMBER 29, 2011

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G011127 SHARON MCCULLER, EMPLOYEE OPINION FILED DECEMBER 29, 2011 BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G011127 SHARON MCCULLER, EMPLOYEE ARKANSAS SPECIALTY ORTHOPAEDICS, EMPLOYER TRAVELERS INDEMNITY CO. OF AMERICA, INSURANCE CARRIER/TPA CLAIMANT

More information

Award of Dispute Resolution Professional. In Person Proceeding Information

Award of Dispute Resolution Professional. In Person Proceeding Information In the Matter of the Arbitration between ADVANCED ORTHOPAEDICS & SPORTS MEDICINE CENTER, PC A/S/O G.B. CLAIMANT(s), Forthright File No: NJ1202001429526 Proceeding Type: In Person Insurance Claim File No:

More information

STATE OF MICHIGAN COURT OF APPEALS

STATE OF MICHIGAN COURT OF APPEALS STATE OF MICHIGAN COURT OF APPEALS BRONSON HEALTH CARE GROUP, INC., d/b/a BRONSON METHODIST HOSPITAL, Plaintiff-Appellant, FOR PUBLICATION March 15, 2016 9:05 a.m. v No. 324847 Kalamazoo Circuit Court

More information

Thomas J. Kibbie v. Killington/Pico Ski Resort (February 5, 2013) STATE OF VERMONT DEPARTMENT OF LABOR

Thomas J. Kibbie v. Killington/Pico Ski Resort (February 5, 2013) STATE OF VERMONT DEPARTMENT OF LABOR Thomas J. Kibbie v. Killington/Pico Ski Resort (February 5, 2013) STATE OF VERMONT DEPARTMENT OF LABOR Thomas J. Kibbie Opinion No. 03-13WC v. By: Jane Woodruff, Esq. Hearing Officer Killington/Pico Ski

More information

Steven M. Goldman, Commissioner, Department of Banking and

Steven M. Goldman, Commissioner, Department of Banking and INSURANCE DEPARTMENT OF BANKING AND INSURANCE DIVISION OF INSURANCE Personal Injury Protection Benefits; Medical Protocols; Diagnostic Tests Deductibles and Co pays Proposed Amendment: N.J.A.C. 11:3 4.4

More information

PROPOSED DRAFT AS OF 2/15/11

PROPOSED DRAFT AS OF 2/15/11 PROPOSED DRAFT AS OF 2/15/11 NEW YORK STATE INSURANCE DEPARTMENT REGULATION NO. 68 (11 NYCRR 65) REGULATIONS IMPLEMENTING THE COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS ACT Subpart 65-0 Subpart

More information

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F201987 ORDER AND OPINION FILED SEPTEMBER 24, 2003

BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F201987 ORDER AND OPINION FILED SEPTEMBER 24, 2003 BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F201987 NANCY SISCO DAS FAMILY, INC. UNION STANDARD INSURANCE CO. CLAIMANT RESPONDENT EMPLOYER RESPONDENT CARRIER ORDER AND OPINION FILED SEPTEMBER

More information