Award of Dispute Resolution Professional
|
|
- Oswald Ball
- 8 years ago
- Views:
Transcription
1 In the Matter of the Arbitration between North Jersey Rehabilitation Center a/s/o Y.L. CLAIMANT(s), Forthright File No: NJ Insurance Claim File No: Claimant Counsel: Joseph M. Ariyan, Esquire, LLC v. Claimant Attorney File No: Respondent Counsel: Law Office of Patricia A. Palma Respondent Attorney File No: DKPO Accident Date: 12/21/2007 High Point Insurance RESPONDENT(s). Award of Dispute Resolution Professional Dispute Resolution Professional: Joseph J. Riva, Esq. I, The Dispute Resolution Professional assigned to the above matter, pursuant to the authority granted under the Automobile Insurance Cost Reduction Act, N.J.S.A. 39:6A-5, et seq., the Administrative Code regulations, N.J.A.C. 11:3-5 et seq., and the Rules for the Arbitration of No-Fault Disputes in the State of New Jersey of Forthright, having considered the evidence submitted by the parties, hereby render the following Award: Hereinafter, the injured person(s) shall be referred to as: Patient An oral hearing was waived by the parties. An oral hearing was conducted on: 09/28/11 Hearing Information Claimant or claimant s counsel appeared in person. Respondent or respondent s counsel appeared in person. The following amendments and/or stipulations were made by the parties at the hearing: The amount of the claim was reduced to $26, NJ Page 1 of 11
2 Findings of Fact and Conclusions of Law This arbitration arises out of an automobile accident that occurred on 12/21/07. On that date, Patient (patient) was an insured of High Point Insurance (respondent) and eligible to receive personal injury protection (PIP) benefits when she suffered injuries because of the accident. Patient received medical care at North Jersey Rehabilitation Center (claimant). Claimant took an assignment of patient s claim for PIP benefits. After a dispute arose between respondent and claimant regarding those benefits, claimant commenced this proceeding, seeking reimbursement from respondent of $26, with interest for unpaid medical bills together with counsel fees and costs. The reimbursement claim is laid out in the Arbitration Summary submitted by claimant, which respondent does not challenge. The issues identified by the parties, confirmed by counsel at the arbitration hearing held on 09/28/11, and presented for my consideration are: (1) whether claimant is entitled to reimbursement of $1, for unpaid chiropractic treatment from 06/03/08 through 08/25/08; (2) whether the additional chiropractic treatment from 08/28/08 through 02/06/09 was medically necessary; (3) whether the acupuncture treatment from 06/03/08 through 07/11/08 was medically necessary; (4) whether the physical therapy (PT) from 08/26/08 through 09/20/08 was medically necessary; (5) whether the manipulations under anesthesia (MUAs) on 12/15/08, 12/17/08 and 12/18/08 were medically necessary; (6) whether claimant failed to abide by respondent s internal appeals process; and (7) counsel fees and costs. The parties did not present any other issues. They agreed that only the issues presented would be decided. Accordingly, I have not considered nor decided any other issues. The parties submitted a number of documents in support of their respective positions for my review, including: Claimant s 02/27/09 Demand for Arbitration with attachments, Claimant s 08/23/11 Arbitration Summary, Claimant s 09/24/11 submission with attached Exhibits A through F, Claimant s counsel s PIP Arbitration Attorney Fee Certification, and Respondent s 11/01/10 submission with attached Exhibits A through XX. I have carefully reviewed all of the parties submissions and considered the arguments of counsel advanced at the hearing. This is a consolidated case with N.J. Anesthesia Group/St. Joseph s a/s/o Y.L., N.J (Forthright, Nov. 9, 2011) and Saddle Brook Surgicenter a/s/o Y.L. v. High Point Ins. Co., N.J (Forthright, Nov. 9, 2011). As a starting point, I agree with claimant that respondent is obligated to make reimbursement of $1, for the unpaid dates of service from 06/03/08 through 08/25/08 as the medical necessity for the services patient received from claimant during that time frame is not disputed. More specifically, claimant is entitled to reimbursement of $1, the amounts reflected as outstanding in claimant s NJ Page 2 of 11
3 Arbitration Summary through 08/21/08 and, additionally, $72.45 for an office visit on 08/25/08 and $ for 2 additional dates of service. The Payment Ledger submitted by respondent indicates that all treatment provided by claimant through 08/21/08 was properly processed and paid. Notably, however, respondent conceded at the hearing that the Ledger reflects codes that are not listed on claimant s Arbitration Summary. This brings me to the medical necessity of the additional chiropractic treatment from 08/28/08 through 02/06/09, the acupuncture treatment from 06/03/08 through 07/11/08, the PT from 08/26/08 through 09/20/08, and the MUAs on 12/15/08, 12/17/08 and 12/18/08. I start my analysis of this issue by stating the applicable regulatory provisions and legal principles. The regulatory definition of the phrase medical necessity is set forth in N.J.A.C. 11:3-4.2 and defined as follows: Medically necessary or medical necessity means that the medical treatment or diagnostic test is consistent with the clinically supported symptoms, diagnosis or indications of the injured person, and: 1. The treatment is the most appropriate level of service that is in accordance with the standards of good practice and standard professional treatment protocols including the Care Paths in the Appendix, as applicable; 2. The treatment of the injury is not primarily for the convenience of the injured person or provider; and 3. Does not include unnecessary testing or treatment. The phrase clinically supported is defined in N.J.A.C. 11:3-4.2 as follows: Clinically supported means 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 ensure that the proper medical indications exist to justify ordering the treatment or test; 2. Physically examined the patient including making an assessment of any current and/or historical subjective complaints, observations, objective findings, neurological indications and physical tests; 3. Considered any and all previously performed tests that relate to the injury and the results and which are relevant to the proposed treatment or test; and 4. Recorded and documented these observations, positive and negative findings and conclusions on the patient s medical records. NJ Page 3 of 11
4 The question of whether medical treatment is necessary is initially decided by the patient s treating physician, and an objectively reasonable belief in the utility of a treatment or diagnostic method based on credible and reliable evidence of its medical value is enough to qualify the expense for PIP purposes. Thermographic Diagnostics, Inc. v. Allstate Ins. Co., 125 N.J. 491, 512 (1991). The treating physician enjoys wide discretionary latitude in determining the extent of treatment needed for a particular patient in that it is not unusual to witness a genuine dichotomy of medical opinion as to the type and extent of treatment needed for a particular injury. Elkins v. N.J. Mfrs. Ins. Co., 244 N.J. Super. 695, 701 (1990); Miskofsky v. Ohio Cas. Ins. Co., 203 N.J. Super. 400, 410 (Law Div. 1984). As a result, when there is a conflict in the opinions of the medical experts regarding a patient s treatment or condition, the treating physician s objectively reasonable belief should be accorded greater weight. Mewes v. Union Bldg. & Constr. Co., 45 N.J. Super. 88, 94 (App. Div. 1957). Guided by these regulatory provisions and legal principles, I turn to an examination of the medical necessity issue in the following factual context. On 04/17/08, patient underwent a pain management independent medical examination (IME) performed by Dr. Boris Parkhina. Dr. Parkhina recorded patient s complaints and described her treatment history. He concluded that there were no positive findings in the cervical, thoracic or lumbar spinal regions. He also concluded that patient s initial complaints could possibly be caused by the 12/21/07 accident, but no permanent injuries resulted therefrom. He determined that patient had reached maximum medical improvement (MMI) and no further treatment was needed with regard to invasive pain management. On 05/05/08, respondent sent a letter to patient advising that Dr. Parkhina concluded that she had reached MMI from pain management treatment resulting from the accident and all pain management treatment would be terminated as of 05/16/08. Patient was subsequently seen by both Dr. William Yu and Hdong Im, LAC (acupuncturist) of claimant, North Jersey Rehabilitation Center, on 06/03/08. At that time, she complained of pain in the neck, radiation into both arms, pain in the mid-back, pain in the low back, and radiation into both legs, along with other symptoms. Dr. Yu indicated that patient had received little improvement with chiropractic treatment and he expected additional chiropractic treatment to last for another 4 to 6 weeks. On 06/03/08, Dr. Yu submitted a treatment plan requesting approval for chiropractic treatment at the rate of 3 times a week for 4 weeks. On 06/05/08, Dr. Yu submitted another treatment plan requesting approval for an MRI of the left shoulder and an MRI of the right shoulder. On 06/06/08, Medical Director, Dr. Thomas Cawley, reviewed Dr. Yu s request for additional chiropractic treatment. He noted that there was still positive neurologic and orthopedic testing, which might indicate a lack of response to treatment. Nevertheless, he determined that treatment at the rate of 3 times a week for 4 weeks should be approved as necessary with patient monitored for progression/persistence of neurologic deficits and a response to chiropractic treatment. As such, Dr. Cawley sent a Certification Letter to Dr. Yu that same day, advising that the requested treatment was approved. NJ Page 4 of 11
5 On 06/10/08, Medical Director, Dr. Alan Stern, reviewed Dr. Yu s request for bilateral shoulder MRIs. He noted that patient had treated with a pain management specialist for quite some time and currently had achieved MMI. He indicated that he was unable to approve the request for bilateral shoulder MRIs because all documented findings were spinal related with no specific shoulder testing performed. He noted that shoulder instability could not be diagnosed from the documented tests and, therefore, the shoulder MRIs were not clinically supported as medically necessary. On 06/10/08, Dr. Stern sent a Denial Letter to Dr. Yu with regard to the request for bilateral shoulder MRIs. Despite the denial, bilateral shoulder MRIs was performed on 06/25/08 at Cliffside Park Imaging and Diagnostic Center. Only tendonitis was revealed but the glenohumeral joint in each shoulder was found to be intact. On 06/30/08, Dr. Yu re-examined patient whose complaints had not improved. He noted that she was at a point in therapy where he was expecting good progress. He encouraged patient to undergo another 4 to 6 weeks of treatment. He submitted a treatment plan on that date requesting approval for an additional 12 sessions of chiropractic treatment as well as an MRI of the left knee and an MRI of the right knee. Patient also saw the acupuncturist, Dr. Im, on 06/30/08, complaining of pain in the head, neck and low back. On that day, Dr. Im submitted a treatment plan requesting approval for acupuncture therapy. On 07/07/08, Medical Director, Dr. Robert Krotenberg, reviewed the request. Dr. Krotenberg noted that patient had neck and back pain for which she had a full course of conservative care far in excess of the Care Path guidelines. He also noted that she had already had a course of acupuncture by another provider but remained symptomatic. He indicated that she had been found to have reached MMI as a result of an IME. He determined that patient had reached MMI and additional acupuncture would unlikely result in long term benefits for her and, therefore, the treatment should be denied. On 07/07/08, Dr. Krotenberg sent a Denial Letter to Dr. Im with regard to the request for acupuncture treatment advising that patient had reached MMI for such treatment. Dr. Im did not appeal the denial. Instead, he submitted additional similar treatment plans on 07/28/08 and 08/18/08. In the meantime, on 07/02/08, Dr. Cawley reviewed Dr. Yu s request for additional chiropractic treatment and MRIs. Dr. Cawley noted that as regards the knee complaints, Dr. Yu did not mention the specific anatomical region either in his report or treatment plan. He noted that patient continued to have neck and low back pain with weakness in all 4 extremities and bilateral knee pain. He determined that additional chiropractic therapy at the rate of 3 times per week for 4 weeks should be approved and that a discharge plan with a total number of visits to date should be supplied by Dr. Yu. He determined that the bilateral knee MRIs should be denied as no specific examination of the knee had been performed or documented. On 07/02/08, Dr. Cawley sent a Certification Letter to Dr. Yu advising that 12 chiropractic visits were approved with a request for a total number of visits to date and a discharge plan. Also, on 07/02/08, Dr. Cawley sent a Denial Letter to Dr. Yu advising that the requested bilateral knee MRIs were denied as inconsistent with the Care Paths and not clinically supported as medically necessary. Despite the denial, NJ Page 5 of 11
6 patient had MRIs of the right and left knees performed on 07/10/08 at Cliffside Park Imaging and Diagnostic Center. On 07/28/08, Dr. Yu again re-examined patient who voiced similar complaints as previously noted. On that date, Dr. Yu submitted another treatment plan, again requesting approval for 12 sessions of chiropractic treatment. On 07/31/08, respondent faxed to Dr. Yu a Certification Letter approving the requested PT and again requesting a copy of a discharge plan and the number of chiropractic visits completed to date. On 08/25/08, patient was again seen by Dr. Yu and complained of similar complaints as previously noted. On that date, Dr. Yu submitted another treatment plan, again requesting 12 sessions of chiropractic therapy. This treatment plan was reviewed on 08/28/08 by Medical Director, Dr. Timothy Hayes, who noted that patient commenced chiropractic treatment on 06/30/08. He also noted that she had undergone 2 trials of chiropractic care and the most recent report of 08/25/08 was reviewed. Dr. Hayes stated that Dr. Yu is notorious for submitting identical reports with little change and, in this case, he compared the initial examination of 06/30/08 to the most recent one and patient s complaints were identical and the findings were almost identical. There was no improvement throughout the 2 trials of chiropractic treatment. He determined that the additional requested treatment should be denied as patient had plateaued and there was no clinical support for the treatment. On 08/28/08, Dr. Hayes sent a Denial Letter to Dr. Yu with regard to the requested additional chiropractic treatment advising that it was not clinically supported. On 09/22/08, Dr. Yu again re-examined patient who had similar continuing complaints as previously noted. On that date, Dr. Yu submitted another treatment plan again requesting approval for 12 sessions of additional chiropractic therapy. On 09/25/08, this treatment plan was reviewed by Dr. Cawley who reiterated that additional treatment would be passive in nature and not consistent with the Care Paths. Because clinical improvement was not apparent after several months of passive therapy, he determined that the additional treatment requested should be denied. On 09/25/08, Dr. Cawley sent a Denial Letter to Dr. Yu. Dr. Yu examined patient again on 10/20/08 and the same complaints were noted. He submitted another treatment plan on 10/20/08 again requesting approval for 12 sessions of additional chiropractic therapy. Dr. Cawley reviewed this request on 10/23/08 and again noted that treatment had become passive with no clinical improvement after several months of chiropractic therapy. He again determined that the request should be denied. On 10/23/08, Dr. Cawley sent another Denial Letter to Dr. Yu with regard to the requested treatment. Dr. Yu examined patient again on 11/17/08, again noting similar complaints and findings. On that date, Dr. Yu submitted another treatment plan requesting an additional 12 sessions of chiropractic therapy. NJ Page 6 of 11
7 Dr. Cawley reviewed this request on 11/20/08 and again noted that there was no clinical improvement with passive therapy which had gone on for several months and, therefore, the request should be denied. On 11/20/08, Dr. Cawley sent a Denial Letter to Dr. Yu. On 12/8/08, Dr. Yu again saw patient who continued to voice similar complaints. On that same date, he submitted a treatment plan requesting approval for MUAs of the spine and hip. On 12/10/08, Dr. Cawley reviewed the request for MUAs. He noted that chiropractic treatment commenced on 06/03/08 and that a re-evaluation of 12/08/08 was submitted. He noted that patient continued to complain of neck and back pain with radiation into all 4 extremities. The symptoms remained unchanged from the initial evaluation back on 06/03/08. He noted that there were multiple positive cervical and lumbar provocative maneuvers bilaterally but no neurologic assessment was performed. He determined that the requested MUAs should be denied as spinal manipulation is no longer the treatment of choice. A plateau had been reached after several months of passive therapy. On 12/10/08, Dr. Cawley sent a Denial Letter to Dr. Yu advising that the requested MUAs were denied as inconsistent with the Care Paths and not clinically supported. On 12/15/08, Dr. Yu again re-examined patient who had continuing similar complaints as previously noted. On that day, Dr. Yu submitted another treatment plan, again requesting approval for additional chiropractic therapy for 12 sessions. Despite the multiple denials of continuing chiropractic care which had become passive and the denials of the requested MUAs, Dr. Yu administered MUAs of the cervical, thoracic and lumbar spine on 12/15/08, 12/17/08 and 12/18/08. On 12/18/08, respondent faxed a letter to Dr. Yu in response to the treatment plan requesting additional chiropractic therapy which was submitted on 12/15/08. Respondent advised Dr. Yu that the treatment had been previously denied by respondent and chiropractic treatment remained denied. No appeals of the denied chiropractic therapy had ever been filed by claimant. On 01/12/09, Dr. Yu again re-examined patient who had continuing similar complaints. On 01/12/09, Dr. Yu submitted another treatment plan again requesting 12 sessions of chiropractic therapy. On 01/15/09, respondent faxed a Final Notification Letter to Dr. Yu acknowledging receipt of the latest treatment plan but advising that it could not be considered because the 30-day time frame within which to appeal had expired. On 02/25/09, Dr. Yu submitted what purports to be an appeal of the treatment which had been denied. The appeal consisted of one sentence which was unsupported by any medical documentation whatsoever and submitted well beyond the 30-day appeal time frame. On 03/03/09, respondent faxed another Final Notice Letter to Dr. Yu acknowledging receipt of the appeal but advising that the 30-day time frame for filing appeals had expired. On 06/05/09, an orthopedic IME was performed by Dr. Alan Miller. Dr. Miller noted that patient continued to complain of pain in the neck, back, right shoulder and bilateral knees. He described patient s treatment in great detail and conducted a thorough clinical examination. Dr. Miller concluded NJ Page 7 of 11
8 that patient had sustained sprains of the cervical spine, lumbar spine, right shoulder and bilateral knees all of which had resolved. He determined that the injuries were causally related to the 12/21/07 accident but there were no permanent injuries resulting therefrom and no need for any further diagnostic testing or treatment of any kind whatsoever. On 06/18/09, respondent sent a letter to patient advising that Dr. Miller had concluded that she had reached MMI from orthopedic treatment and that all treatment would be terminated as of 07/02/09. On 10/29/09, Dr. Cawley undertook a peer review of the medical necessity of the MUAs, which had been performed and also of the chiropractic treatment provided on 73 dates from 08/26/08 through 02/04/09. Dr. Cawley concluded that the MUAs were not clinically supported as medically necessary and were properly denied by respondent. He also determined that all chiropractic care prior to 08/26/08 was medically necessary but the 73 dates of service beyond that date were not clinically supported as medically necessary. Where there is a dispute as to PIP benefits, the burden rests on the claimant to establish by a preponderance of the evidence; that is, the greater weight of the credible evidence, that the services for which PIP payment is sought were reasonable, medically necessary and causally related to an automobile accident. Miltner v. Safeco Ins. Co. of Am., 175 N.J. Super. 156 (Law Div. 1980). While it is true the treating physician s opinion is not automatically accorded conclusive weight, Black & Decker Disability Plan v. Nord, 123 S. Ct (2003), (relating to ERISA Plans), it is accorded an appropriate measure of deference. Having considered the arguments advanced by counsel in light of the record and applicable legal framework, I conclude that the additional chiropractic treatment from 08/28/08 through 02/06/09 was properly denied by respondent as not medically necessary and in excess of the Care Paths. A review of claimant s written notes demonstrate no significant changes in patient s condition that would justify continued conservative care. Accordingly, I deny the additional amount of reimbursement sought as reflected in claimant s Arbitration Summary. I further conclude that the PT from 08/26/08 through 09/20/08 was properly denied by respondent as not medically necessary. Accordingly, I deny the reimbursement claim of $1, for the PT from 08/26/08 through 09/20/08. In light of the conclusion reached by Dr. Cawley as a result of his 10/29/09 peer review; namely, that all chiropractic care prior to 08/26/08 was medically necessary, I conclude that the contemporaneous acupuncture from 06/03/08 through 07/11/08 was medically necessary. Accordingly, I award claimant $2, for the acupuncture treatment. Finally, I conclude that the MUAs performed on 12/15/08, 12/17/08 and 12/18/08 were not medically necessary. The treating records point out that patient had reached a plateau after 3 months of chiropractic treatment. Based on a comparison of the examinations, I find that the chiropractic treatment did not result in any significant improvement. The proofs show that patient s complaints did not improve after the MUAs were performed and actually worsened, which confirms that patient was not a candidate for the MUAs, and I so find. NJ Page 8 of 11
9 Moreover, the National Academy Of Manipulation Under Anesthesia Physicians (NAMUAP) protocols identify the conditions that provide clinical justification for MUAs. The proofs presented here fall short of demonstrating that patient s condition satisfied the protocols. In fact, the records reveal that patient was not responding to chiropractic treatment as her condition was chronic. Notably, the protocols do not state that MUAs are appropriate where a patient s condition has become chronic. Rather, they state that MUAs may be useful where the chronicity of the problem and/or the presence of fibrous adhesions render conservative manipulations incomplete. Here, however, there is no indication from Dr. Yu that his manipulations were incomplete. Indeed, the records simply do not reveal that he was having difficulty manipulating patient due to pain or adhesions. MUA is designed to relax the patient so that the chiropractor can achieve a proper manipulation of the joint that he/she otherwise would not be able to do because of pain or adhesions or muscle splinting. The mere failure to respond to conservative care is not a basis to perform MUA. Based upon the proofs presented, I conclude that there was no need to perform the MUAs. Beyond that, Dr. Yu failed to follow the protocols in performing the second and third MUAs. The protocols state that if the patient gains 80% or more biomechanical function during the first procedure and retains at least 80% of functional improvement during the post MUA evaluation, then serial MUA is unnecessary. If the patient achieves less than a 50% improvement, then a subsequent MUA would not be useful. Unquestionably, the protocols require that a post-mua evaluation be done. There is no record of any post-mua evaluation being done here. In fact, the 3 procedures were performed within 4 days, which suggests that Dr. Yu proceeded to perform a second and third MUA without even considering if they were needed. Under these circumstances, I deny the reimbursement claim as regards the MUAs. Accordingly, respondent s argument that claimant excessively billed for cervical, lumbar and thoracic MUA on each date is moot. On a final note, I reject respondent s argument that claimant is barred from recovery for failing to abide by its internal appeals process given Dr. Cawley s 10/29/09 peer review. Turning to counsel fees and costs, claimant s counsel seeks counsel fees in the amount of $1,920 together with costs of $ Respondent s counsel objects to such an award with particular opposition to both the total number of hours billed and the hourly billing rates. It is respondent counsel s position that the counsel fee requested is excessive and not consonant with the amount at issue and, moreover, that respondent is not obligated to pay for the services rendered by the paralegal, law clerk and secretary. In N.J. Coalition of Health Care Professionals, Inc. v. N.J. Dep t of Banking & Ins., 323 N.J. Super. 207 (App. Div. 1999), the court noted that an award of counsel fees to an insured who successfully obtains an arbitration award against an insurance carrier for payment of PIP benefits... has been the statutory and historical jurisprudence of our State. The courts have construed Rule 4:42-9(a)(6), which allows for an award of counsel fees in an action upon a liability or indemnity policy of insurance in favor of a NJ Page 9 of 11
10 successful claimant, to permit an award of attorney's fees and judicial actions brought under the PIP statute. I find the claimant was successful and is entitled to an award of counsel fees. In Enright v. Lubow, 215 N.J. Super. 306 (App. Div. 1987), the court identified the factors to be considered in deciding whether to award attorney s fees, including the insurer's good faith in refusing to pay the claim, the excessiveness of plaintiff's demands, the bona fides of the parties, the insurer's justification in litigating the issues, the insurer's conduct as it contributes substantially to the need for litigation, the general conduct of the parties, and the totality of the circumstances. As the court pointed out in Scullion v. State Farm Ins. Co., 345 N.J. Super. 431 (App. Div. 2001), while the Enright factors are to be considered in making the threshold determination as to whether to award counsel fees, many of those factors are equally applicable in determining the amount of counsel fees to be awarded. The court in Scullion clearly suggests that the proper determination of the amount of counsel fees to be awarded requires a line by line analysis of the various certifications of services to determine whether hours expended by counsel or excessive for what appeared to be routine efforts. I have carefully reviewed the Attorney Fee Certification submitted by claimant s counsel. I have also carefully considered the arguments advanced by counsel. I am mindful of the fact that any amount awarded as counsel fees must be consonant with the amount at issue. I am also mindful of the fact that the claimant was only partially successful in this action. I find that an award of counsel fees in the amount of $1,200 is consonant with the amount at issue and consistent with the requisites of R.P.C. 1.5 as well as with the degree of effort, expertise and experience required for a successful prosecution of this claim. I also award costs in an amount of $225.00, representing the filing fee. I deny the photocopying costs of $ and the postage costs of $ Therefore, the DRP ORDERS: NJ Page 10 of 11
11 1. Medical Expense Benefits: Awarded: Disposition of Claims Submitted Medical Provider Amount Claimed Amount Awarded Payable To North Jersey Rehabilitation Center $26, $3, North Jersey Rehabilitation Center 2. Income Continuation Benefits: Not in issue 3. Essential Services Benefits: Not in issue 4. Death or Funeral Expense Benefits: Not in issue 5. Interest: I find that the Claimant did prevail. Interest is awarded pursuant to N.J.S.A. 39:6A-5h.: Interest shall be calculated by respondent Attorney s Fees and Costs I find that the Claimant did not prevail and I award no costs and fees. I find that the Claimant prevailed and I award the following costs and fees (payable to Claimant s attorney unless otherwise indicated) pursuant to N.J.S.A. 39:6A-5.2g: Costs: $ Attorney s Fees: $ 1,200 THIS AWARD is rendered in full satisfaction of all claims and issues presented in the arbitration proceeding. Entered in the State of New Jersey Date: 11/09/11 NJ Page 11 of 11
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 informationAward 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 informationA 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 19775 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 19775 03 v.
More informationA 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 informationAward 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 informationAward 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 informationAward 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 informationAward 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 informationIn 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 informationHow To Find Out If You Can Get A Medical Expense Benefit From A Car Accident
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 informationAward 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 informationAward 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 informationAward 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 informationA 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 informationCARE 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 informationCURE 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 informationCOMPENSATION 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 informationPERSONAL 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 informationOverview 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 informationSOAH DOCKET NO. 453-04-4583.M2 TWCC MR NO. M2-04-0846-01 ' ' ' ' ' ' ' DECISION AND ORDER I. JURISDICTION, NOTICE, AND VENUE
SOAH DOCKET NO. 453-04-4583.M2 TWCC MR NO. M2-04-0846-01 FIRST RIO VALLEY MEDICAL, P.A., Petitioner V. AMERICAN HOME ASSURANCE CO., Respondent BEFORE THE STATE OFFICE OF ADMINISTRATIVE HEARINGS DECISION
More informationOur 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 informationThe 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 informationFor 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 informationIMPORTANT 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 informationNew 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 informationAward 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 informationAward 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 informationState 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 informationHow To Get Reimbursed For A Car Accident
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 informationThomas 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 informationCompany 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 informationBEFORE 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 informationThe 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 informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G204754. JENNIFER WILLIAMS, Employee. MERCY HOSPITAL FORT SMITH, Employer
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G204754 JENNIFER WILLIAMS, Employee MERCY HOSPITAL FORT SMITH, Employer SISTERS OF MERCY HEALTH SYSTEM, Carrier CLAIMANT RESPONDENT RESPONDENT
More informationSOAH DOCKET NO. 453-04-5358.M5 TWCC MR NO. M5-04-0130-01 DECISION AND ORDER
SOAH DOCKET NO. 453-04-5358.M5 TWCC MR NO. M5-04-0130-01 TEXAS MUTUAL INSURANCE COMPANY, Petitioner V. MICHAEL M. STELZER, D.C., Respondent BEFORE THE STATE OFFICE OF ADMINISTRATIVE HEARINGS DECISION AND
More informationPIP 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 informationKey Provisions of Tennessee Senate Bill 200 Effective July 1, 2014, through July 1, 2016
2014 Construction of Statute Definition of Injury (Causation) Revises Section 50-6-116, Construction of Chapter, to indicate that for dates of injury on or after July 1, 2014, the chapter should no longer
More informationChrista Hoisington v. Ingersoll Electric (December 28, 2009) STATE OF VERMONT DEPARTMENT OF LABOR. By: Phyllis Phillips, Esq. v.
Christa Hoisington v. Ingersoll Electric (December 28, 2009) STATE OF VERMONT DEPARTMENT OF LABOR Christa Hoisington Opinion No. 52-09WC By: Phyllis Phillips, Esq. v. Hearing Officer Ingersoll Electric
More informationFILED November 18, 2014 released at 3:00 p.m. RORY L. PERRY II, CLERK SUPREME COURT OF APPEALS OF WEST VIRGINIA
IN THE SUPREME COURT OF APPEALS OF WEST VIRGINIA September 2014 Term No. 11-1503 FILED November 18, 2014 released at 3:00 p.m. RORY L. PERRY II, CLERK SUPREME COURT OF APPEALS OF WEST VIRGINIA RE: PETITION
More informationTina Ploof v. Franklin County Sheriff s Department and (August 8, 2014) Trident/Massamont STATE OF VERMONT DEPARTMENT OF LABOR
Tina Ploof v. Franklin County Sheriff s Department and (August 8, 2014) Trident/Massamont STATE OF VERMONT DEPARTMENT OF LABOR Tina Ploof Opinion No. 13-14WC v. By: Phyllis Phillips, Esq. Hearing Officer
More informationL. 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 informationNew 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 informationBEFORE 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 informationSTATE 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 informationIMPORTANT 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 information10 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 informationIN THE COURT OF APPEALS OF THE STATE OF MISSISSIPPI NO. 2013-WC-02083-COA HOWARD INDUSTRIES INC. MISSISSIPPI WORKERS COMPENSATION APPEALED:
IN THE COURT OF APPEALS OF THE STATE OF MISSISSIPPI NO. 2013-WC-02083-COA ELSA PEREZ APPELLANT v. HOWARD INDUSTRIES INC. APPELLEE DATE OF JUDGMENT: 11/27/2013 TRIBUNAL FROM WHICH MISSISSIPPI WORKERS COMPENSATION
More informationHow To Get A Spinal Cord Stimulator
BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION MICHAEL L. McDONALD Claimant VS. FIBERGLASS SYSTEMS, LP Respondent Docket No. 1,003,977 AND PACIFIC EMPLOYERS INS. CO. Insurance
More informationBEFORE 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 informationMARITIME WORKER JOB RELATED INJURY
JEFFREY S. MUTNICK, P.C. jmutnick@mutnicklaw.com Admitted in Oregon MARITIME WORKER JOB RELATED INJURY As a maritime worker, your employer must provide compensation for job-related injuries. This entitlement
More informationHAWAI`I REVISED STATUTES CHAPTER 672B DESIGN CLAIM CONCILIATION PANEL. Act 207, 2007 Session Laws of Hawai`i
HAWAI`I REVISED STATUTES CHAPTER 672B DESIGN CLAIM CONCILIATION PANEL Act 207, 2007 Session Laws of Hawai`i Section 672B-1 Definitions 672B-2 Administration of chapter 672B-3 Design claim conciliation
More informationMetLife 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 informationUTILITY COMPLAINT HANDLING PROCEDURES OF THE NEW YORK STATE PUBLIC SERVICE COMMISSION
UTILITY COMPLAINT HANDLING PROCEDURES OF THE NEW YORK STATE PUBLIC SERVICE COMMISSION New York s Utility Project Law Manual 6th Edition 2013 New York s Utility Project P.O. Box 10787 Albany, NY 12201 1-877-669-2572
More information2:08-cv-12533-DPH-PJK Doc # 67 Filed 03/26/13 Pg 1 of 7 Pg ID 2147 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION
2:08-cv-12533-DPH-PJK Doc # 67 Filed 03/26/13 Pg 1 of 7 Pg ID 2147 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION OLD REPUBLIC INSURANCE COMPANY, v. Plaintiff, MICHIGAN CATASTROPHIC
More informationDECISION 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 informationGEICO 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 informationBEFORE 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 informationUNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT. Nos. 01-3935; 02-3663; 02-3902
UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT Nos. 01-3935; 02-3663; 02-3902 1 NOT PRECEDENTIAL BINTOU K. DIENG, as the Intended Third Party Beneficiary of the Policy of Insurance/Self-Insurance
More informationWORKERS COMPENSATION BOARD APPEAL TRIBUNAL. [Personal information] CASE I.D. #[personal information]
WORKERS COMPENSATION BOARD APPEAL TRIBUNAL BETWEEN: [personal information] CASE I.D. #[personal information] PLAINTIFF AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND DEFENDANT DECISION #41 [Personal
More informationENCOMPASS 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 informationNOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. JANENE RUSSO and GARY RUSSO, v. Plaintiffs-Respondents, CHUBB INSURANCE COMPANY
More informationCountryway 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 informationDECISION 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 information00/00/00 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 informationDECISION 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 informationBEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION
BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION DALE L. STILWELL ) Claimant ) VS. ) ) BOEING COMPANY and ) Docket Nos. 253,800 CESSNA AIRCRAFT COMPANY ) & 1,031,180 Respondents
More informationDECISION 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 informationINITIAL 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 informationWorkplace Health, Safety & Compensation Review Division
Workplace Health, Safety & Compensation Review Division WHSCRD Case No: 13252-11 WHSCC Claim No.(s): 604016, 611050, 672511 705910, 721783, 731715, 753775, 784014, 831110 Decision Number: 14189 Marlene
More informationIN THE COURT OF APPEALS OF INDIANA
Pursuant to Ind. Appellate Rule 65(D), this a Memorandum Decision shall not be regarded as precedent or cited before any court except for the purpose of establishing the defense of res judicata, collateral
More informationSOUTH 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 informationAmerican 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 informationSUBCHAPTER 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 informationJohn Coronis v. Granger Northern Inc. (April 27, 2010) STATE OF VERMONT DEPARTMENT OF LABOR
John Coronis v. Granger Northern Inc. (April 27, 2010) STATE OF VERMONT DEPARTMENT OF LABOR John Coronis Opinion No. 16-10WC v. By: Sal Spinosa, Esq. Hearing Officer Granger Northern, Inc. ATTORNEYS: For:
More informationNOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
TINA L. TALMADGE, v. Plaintiff-Appellant, NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION CONNIE S. BURN and ALVAN A. BURN, and Defendants, THE HARTFORD, Defendant/Intervenor- Respondent.
More informationDECISION 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 informationProving Causation and Damages in Spinal Fusion Cases
Page 1 of 7 Ben Brodhead on proving causation and damages in spinal fusion cases. Friend on Facebook Follow on Twitter Forward to a Friend Proving Causation and Damages in Spinal Fusion Cases By: Ben C.
More informationNOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. HAN HUNG LUONG, v. Plaintiff-Appellant, FRANK T. GEORGE, and Defendant-Respondent,
More informationWorkers 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 informationARBITRATION RULES OF THE COURT OF ARBITRATION AT THE POLISH CHAMBER OF COMMERCE
ARBITRATION RULES OF THE COURT OF ARBITRATION AT THE POLISH CHAMBER OF COMMERCE Chapter I Introductory provisions 1 Court of Arbitration 1. The Court of Arbitration at the Polish Chamber of Commerce (the
More informationINITIAL 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 informationTHE THREAT OF BAD FAITH LITIGATION ETHICAL HANDLING OF CLAIMS AND GOOD FAITH SETTLEMENT PRACTICES. By Craig R. White
THE THREAT OF BAD FAITH LITIGATION ETHICAL HANDLING OF CLAIMS AND GOOD FAITH SETTLEMENT PRACTICES By Craig R. White SKEDSVOLD & WHITE, LLC. 1050 Crown Pointe Parkway Suite 710 Atlanta, Georgia 30338 (770)
More informationSOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT WORKERS COMPENSATION. CALVIN BOSWORTH, HF No. 173, 2008/09
SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT WORKERS COMPENSATION CALVIN BOSWORTH, HF No. 173, 2008/09 Claimant, v. DECISION P.I.E INC., and CONTINENTAL WESTERN INSURANCE COMPANY v.
More informationIN THE COMMONWEALTH COURT OF PENNSYLVANIA
IN THE COMMONWEALTH COURT OF PENNSYLVANIA Carmelo Olivares Hernandez, No. 2305 C.D. 2014 Petitioner Submitted May 15, 2015 v. Workers Compensation Appeal Board (Giorgio Foods, Inc.), Respondent BEFORE
More informationOne Third Contingent Fee Agreement with Waiver of Sliding Scale
Appendix II One Third Contingent Fee Agreement with Waiver of Sliding Scale, 2008 NAME OF CLIENT: DATE OF INJURY: JACOBS, GRUDBERG, BELT, DOW & KATZ P.C. ATTORNEY CONTINGENT FEE AGREEMENT WITH WAIVER OF
More informationBEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION
BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION TINA M. BREWER ) Claimant ) VS. ) ) Docket No. 1,037,976 CALAMAR ) Respondent ) AND ) ) ACE AMERICAN INSURANCE COMPANY ) Insurance
More informationIN THE COUNTY COURT OF THE THIRTEENTH JUDICIAL CIRCUIT HILLSBOROUGH COUNTY, FLORIDA CIVIL DIVISION
IN THE COUNTY COURT OF THE THIRTEENTH JUDICIAL CIRCUIT HILLSBOROUGH COUNTY, FLORIDA CIVIL DIVISION CHIROPRACTIC CLINICS, INC. (as assignee of Barbara Barriga), Plaintiff, vs. Case No. 03-00079-SC Division
More informationv. CASE NO.: 2010-CV-15-A Lower Court Case No.: 2008-CC-19076-O
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR ORANGE COUNTY, FLORIDA MAURICIO CHIROPRACTIC WEST, as assignee of Alesha Kirkland, Appellant, v. CASE NO.: 2010-CV-15-A Lower Court Case No.:
More informationFREQUENTLY 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 informationMARCH 5, 2015. Referred to Committee on Commerce and Labor. SUMMARY Revises provisions governing workers compensation.
A.B. ASSEMBLY BILL NO. COMMITTEE ON COMMERCE AND LABOR MARCH, 0 Referred to Committee on Commerce and Labor SUMMARY Revises provisions governing workers compensation. (BDR -) FISCAL NOTE: Effect on Local
More informationBEFORE 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 informationGuide. to Recovery Under The Illinois Workers Compensation Act. The Injured Employee s
The Injured Employee s Guide to Recovery Under The Illinois Workers Compensation Act Prepared By: Romanucci & Blandin, LLC 33 North LaSalle Street, 20th Floor Chicago, Illinois 60602 Toll Free: 888.458.1145
More informationSTATE 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 informationSAN DIEGO COUNTY WATER AUTHORITY EMERGENCY STORAGE PROJECT LABOR AGREEMENT. Appendix B
SAN DIEGO COUNTY WATER AUTHORITY EMERGENCY STORAGE PROJECT LABOR AGREEMENT Appendix B Workers Compensation. 1. The Contractor and the Union parties to the Emergency Storage Project Labor Agreement (the
More informationTHE MAJOR IMPACT OF THE NEW MINOR INJURIES CATEGORY
THE MAJOR IMPACT OF THE NEW MINOR INJURIES CATEGORY By Cary N. Schneider September, 2010 VOL. 4, ISSUE 4 Cary N. Schneider is a partner at Beard Winter LLP who specializes in accident benefit and tort
More information13-22840-rdd Doc 402 Filed 10/25/13 Entered 10/25/13 16:17:31 Main Document Pg 1 of 10. (Jointly Administered)
Pg 1 of 10 UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF NEW YORK -----------------------------------------------------------x In re: SOUND SHORE MEDICAL CENTER OF WESTCHESTER, et al., 1 Debtors.
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/15
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/15 BEFORE: E. Kosmidis : Vice-Chair E. Tracey : Member Representative of Employers C. Salama : Member Representative of Workers HEARING:
More informationIn The Court of Appeals Fifth District of Texas at Dallas. No. 05-12-00561-CV. ROBERT MILLER, Appellant V. MATTHEW AARON CHURCHES, Appellee
AFFIRM; and Opinion Filed December 11, 2013. S In The Court of Appeals Fifth District of Texas at Dallas No. 05-12-00561-CV ROBERT MILLER, Appellant V. MATTHEW AARON CHURCHES, Appellee On Appeal from the
More information[J-119-2012] [MO: Saylor, J.] IN THE SUPREME COURT OF PENNSYLVANIA MIDDLE DISTRICT : : : : : : : : : : : : DISSENTING OPINION
[J-119-2012] [MO Saylor, J.] IN THE SUPREME COURT OF PENNSYLVANIA MIDDLE DISTRICT HERD CHIROPRACTIC CLINIC, P.C., v. Appellee STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant No. 35 MAP 2012 Appeal
More informationHow To Write A Plan For A Car Accident In New Jersey
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