Proving the Necessity of Chiropractic Treatment
In the No Fault arbitration system, the legal obligation to demonstrate medical necessity rests with the provider. For chiropractic physicians, this burden is unique. Your care is based on a distinct diagnostic framework focused on biomechanical function and the musculoskeletal system, often for conditions like whiplash and spinal subluxations that are central to auto accident injuries.
Insurance carriers frequently challenge chiropractic claims by alleging that the treatment plan is excessive, not directly accident related, or that the underlying diagnosis lacks sufficient objective findings. They rely on reports from medical doctors in other specialties who may not fully recognize chiropractic methodologies, creating a significant barrier to securing payment for your essential rehabilitative services.
Our Strategic Solution: Validating the Chiropractic Treatment Plan
At Choudhry &Franzoni Law Group, we specialize in fighting for chiropractic physicians. We understand that proving the necessity of your care requires constructing a clear narrative that connects the traumatic mechanism of the accident to your specific diagnostic findings and the reasoned progression of your treatment.
Our legal team builds a compelling case by meticulously compiling a complete record. This includes the initial accident report, any emergency room documentation, your detailed initial examination with range of motion studies and orthopedic testing, progress notes that document objective improvements, and all supporting documentation. We demonstrate how each phase of your care was a logical and necessary response to the patient’s documented spinal injury, aligning your clinical expertise with the requirements of No-Fault law.
Deconstructing No-Fault Denials Targeting Chiropractic Care
When insurers deny your claims, we conduct a rigorous defense of your professional judgment. Our analysis specifically targets the common denial tactics used against chiropractic providers:
Fee Schedule Denials
We challenge improper reductions or denials based on incorrect coding or the misapplication of New York’s No Fault fee schedules to your chiropractic manipulations, therapies, and evaluations. We ensure you are reimbursed at the correct allowable rate for your distinct services.
Peer Review Denials
We systematically deconstruct reports from insurance retained medical doctors who question the necessity of chiropractic care. We expose weaknesses such as the reviewer’s lack of familiarity with chiropractic standards of care, their dismissal of your documented objective findings like palpation or asymmetry, and their failure to consider the conservative, non invasive nature of your treatment plan.
Independent Medical Examination Denials- IME Denials
We aggressively counter denials based on biased IME reports. We highlight the IME physician’s potential lack of training or bias against chiropractic methods, the superficial nature of an exam that may not assess functional chiropractic findings, and the direct contradiction between the IME opinion and your longitudinal treatment records.
Allegations of Overutilization
We defend against claims that the frequency or duration of care was excessive. We present your treatment notes to demonstrate a clear plan with documented re examinations, measurable progress, and appropriate discharge planning, proving the care was both reasonable and necessary.
Our Targeted Process for Chiropractic No Fault Arbitrations
Choudhry & Franzoni Law Group manages the entire legal and administrative burden, allowing you to focus on your patients. To build the strongest possible case for your practice, we will work with you to gather:
- Assignment of Benefits forms
- All insurance denial letters and Explanations of Benefits
- A complete billing ledger for disputed services
- Your detailed initial examination report, daily SOAP notes, and re evaluation reports
- Any supporting documentation such as outcome assessment forms or patient intake histories
- All prior medical records related to the accident
- Any Independent Medical Examination or peer review reports from the insurer
Let Choudhry & Franzoni Law Group Handle Arbitration For Your Denials
From formal arbitration and appeals, our firm serves as your dedicated legal partner. We are committed to ensuring you receive full compensation for the vital, conservative care you provide to accident victims.
We understand the specific challenges chiropractors face in the No Fault system and provide clear, aggressive representation to protect your practice’s revenue.
If your practice has provided necessary chiropractic treatment following a car accident and has been met with unjustified delays or denials, you have the right to binding arbitration.
