First things first: Statute of Limitations
The time to file a valid No Fault coverage dispute is generally six years from the date the denial was issued by the carrier. This date can be found on the bottom left-hand corner of the denial form (NF-10).
Risks and Benefits of Arbitration
A valid NF-10 form will advise you that you have the right to file your arbitration demand (AR-1) with the American Arbitration Association or to file a lawsuit in order to dispute the denial. Arbitration is generally less costly and time consuming than litigating a matter. Additionally, the strict New York evidentiary rules are a bit more relaxed. Because of the relaxed treatment of evidence, insurance carriers have an easier time presenting their defense and possible winning the case. Arbitration is recommended if there is no dispute regarding the validity of the insurance carrier's claim process.
Risks and Benefits of Litigation
Although litigating a No Fault matter is potentially more costly and more time consuming, it has distinct advantages for a health care provider or insured. The New York rules of evidence are applied and insurance companies have to make a cost/benefit analysis to decide whether to send multiple witnesses and hire doctors to present a defense to the NF-10. Many times the result of this analysis is a fair settlement of your bill or claim or possible loss to the carrier at trial. Litigation is recommended if issues exist with the NF-10 or other documents supporting the insurer's denial.