The verification process in no-fault claims can be an irritating headache. Insurance companies can make demands, and you have no idea how to meet them. Insurers may even request information and records that you do not have.
When you have frustrating requests from an insurance company with no clue how to handle them, turn to The Tadchiev Law Firm, P.C., for the experienced legal help you need.
At The Tadchiev Law Firm, P.C., we have a deep knowledge of the claims system. We understand how overwhelming the process can feel. When you are facing the challenges of a no-fault claim, allow us to take the pressure off you. We intentionally keep a smaller caseload, so we can give your case the attention it needs. Our promise: We will always provide the aggressive advocacy and personalized service that you deserve.
Contact The Tadchiev Law Firm, P.C., today to learn how we can help you through the no-fault verification process.
We serve clients across New York, including Nassau County, New York City, Long Island, and Floral Park.
What to Expect in the No-Fault Verification Process
In a typical verification process, insurance carriers will request documents and other information in support of your no-fault claim. Depending on the insurance company and its processes, you may receive requests that seem excessive or out-of-line.
Insurance companies may make a wide range of requests for information, but they are subject to certain restrictions. The bottom line: you do not have to provide everything the insurance companies ask for.
As part of the process, you can expect to experience some delays from the insurance company. The law allows delays in certain circumstances. For instance, a delay is permitted when the insurer is waiting for third-party documentation. In some cases, however, an insurance company may delay your claim without reason. At times like that, it is important to know your rights and responsibilities under New York law.
The FAQs on this page answer common questions that medical providers have about the verification process. If you have other questions about your claim, contact The Tadchiev Law Firm, P.C., today.
What Is the Timeline for Insurance Carriers in Their Requests for Additional Verification?
An insurance carrier must send its initial request for additional verification within 30 days after receipt of the claim. If the carrier does not receive a verification response within 30 days after sending its request, the carrier must send a follow-up request within 10 calendar days.
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Are There Any Limits on What Information or Documentation an Insurance Carrier Can Request?
An insurer is entitled to receive all items necessary to verify the claim. However, the additional verification requested should have a rational or reasonable relationship to the specific claim. This means that the verification requested must be relevant to the insurer’s decision on whether to pay or deny the claim.
Similarly, the no-fault regulations require “good reason” for delaying claims for information via verification requests. It has been held, for example, that an insurer did not have a good faith basis to request color photographs of a surgery in order to process a bill.
How Long Does a Medical Provider Have to Respond to Requests for Additional Verification?
A medical provider has 120 calendar days after the carrier’s initial verification request to either submit all requested documentation in its possession or provide reasonable justification for failure to comply with the verification request.
In the event a medical provider either submits a late verification response or fails to provide any response, the provider may still be entitled to payment for the claim if the insurance carrier fails to meet certain requirements. To determine whether you can receive payment for those types of claims, ask a no-fault law firm to review your claim. Contact The Tadchiev Law Firm, P.C., today.
Get Legal Help with Your No-Fault Claim in Queens, NY
If you are dealing with a no-fault claim in Queens, contact The Tadchiev Law Firm, P.C., today. Our experienced no-fault attorneys understand the claims process and how to navigate it from start to finish. We will give you the personalized service that you deserve, and we will represent you and your claims as aggressive advocates. No-fault claims can be a hassle, but with The Tadchiev Law Firm, P.C., on your side, they do not have to be.
To learn more about how we can help, contact The Tadchiev Law Firm, P.C., today at (718) 380-1200.
FAQs About the Verification Process
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