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Today's Rogak Report-denials of claim

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  • deg630
    Regarding today s Rogak Report decision, (11-3-03) I have a question. I m not sure of the specific facts of this case, but did the carrier initially issue a
    Message 1 of 1 , Nov 3, 2003
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      Regarding today's Rogak Report decision, (11-3-03) I have a question.
      I'm not sure of the specific facts of this case, but did the carrier
      initially issue a denial to the medical provider and insured for
      excessive treatment? Or was the denial only to the insured? I have
      had instances where I have recommended that a no-fault carrier not
      respond to every bill submitted by the same medical facility
      repeatedly. Example; A claimant is denied due to concurrent care
      and/or an IME. The denial is sent to the claimant, his or her
      attorney, the main doctor, and all other treating providers. The
      provider whose bills are denied still submits bills months after
      receiving the denial from the carrier. A letter is sent advising him
      that the bills will not be paid, and enclosing a copy of the
      previously sent denials. Can he prevail in litigation if an NF-10 was
      not resent in response to every single bill submitted?

      According to the dissenting judge in the Rogak report today, this is
      redundant. I happen to agree, but my question is this-Was the
      deciding factor in this decision the fact that the NF-10 was not sent
      to the medical provider, or that it was not continually sent as bills
      were being submitted?
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