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New York Insurance Bad Faith Questions & Answers
1 Answer | Asked in Insurance Bad Faith for New York on
Q: I was rear-ended at a red light by 2 vehicles and injured badly. The claims adjuster will not give me any lost wages

This process has been dragged since the day of the accident which is July 24, 2024. I’ve received one very small payment in almost 4 months. I feel like I’m being punished for even filing

a claim… I’ve had utilities shut off, car insurance policy cancellation, phone shut off, etc.... View More

Tim Akpinar
Tim Akpinar
answered on Nov 2, 2024

I'm sorry about your accident and the upheaval that it has caused in your life. I hope you are okay and recovering from your injuries. What you describe is not uncommon. Although no-fault benefits under New York insurance law cover medical expenses and lost wages, self-employed claimants often... View More

1 Answer | Asked in Insurance Bad Faith for New York on
Q: My $3000 motorbike was stolen. Insurance suggests it was intentional. After hours of calls and many docs requested, shou

My $3000 electric motorbike was stolen two months ago, and there are security photos of the theft. The insurance company, suspicious due to the bike being taken out of storage two days before, implies the theft was intentional. After 5 hours of phone calls and now being asked for numerous... View More

Tim Akpinar
Tim Akpinar
answered on Jul 30, 2024

I'm sorry your motorbike was stolen. The answer to your question is an individual call. Your frustration is understandable. If you're thinking of bringing an attorney on board, you could start reaching out to law firms to try to arrange free consults to discuss their terms for assisting... View More

2 Answers | Asked in Insurance Bad Faith for New York on
Q: Can a doctor recode and bill insurance after receiving a denial claim?

A patient was seen as a new Medicare wellness visit but had previously had one within the year by another physician unbeknownst to the office. So the claim was denied and the Dr. Wants to recode and resubmit.

Tim Akpinar
Tim Akpinar
answered on Sep 29, 2023

They generally can. I'm not certain of the specific rules for Medicare billing, but in just about all forms of insurance for health care claims, examiners can delay claims for CPT coding errors and allow a medical office to resubmit claims with the proper codes. It also depends on the... View More

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2 Answers | Asked in Insurance Bad Faith for New York on
Q: Can a doctor recode and bill insurance after receiving a denial claim?

A patient was seen as a new Medicare wellness visit but had previously had one within the year by another physician unbeknownst to the office. So the claim was denied and the Dr. Wants to recode and resubmit.

T. Augustus Claus
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answered on Sep 28, 2023

In New York, a doctor generally can recode and resubmit a claim to insurance if the original claim was denied. However, the recoding must accurately reflect the services provided, and the practice could be subject to audit. Additionally, Medicare has specific rules and timelines for resubmitting... View More

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3 Answers | Asked in Insurance Bad Faith, Medical Malpractice and Personal Injury for New York on
Q: Is there liability for a insurance company if my condition worsens due to their denial of authorization for more PT?

I was undergoing physical therapy for back/ spine issues with intermittent numbness and improving. Additional authorizations by my insurer were suddenly denied. PT office did not appeal immediately and only did once I received a copy of the letter and informed them. An appeal would take 30 days to... View More

Jonathan R. Ratchik
Jonathan R. Ratchik
answered on Sep 19, 2023

Sorry to hear what you've been going through. It is unlikely that your insurance company would be responsible for any physical harm you sustained due to its denial (or delay) in approving additional physical therapy visits. Although you could conceivably claim that the insurance... View More

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3 Answers | Asked in Insurance Bad Faith, Medical Malpractice and Personal Injury for New York on
Q: Is there liability for a insurance company if my condition worsens due to their denial of authorization for more PT?

I was undergoing physical therapy for back/ spine issues with intermittent numbness and improving. Additional authorizations by my insurer were suddenly denied. PT office did not appeal immediately and only did once I received a copy of the letter and informed them. An appeal would take 30 days to... View More

Tim Akpinar
Tim Akpinar
answered on Sep 16, 2023

You raise a very good question - and one that does not go overlooked by attorneys in challenging denials of medical care. Unfortunately, it is also a difficult issue to argue in most settings where a claim is closely processed with valid independent medical exams or peer reviews. If you have an... View More

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1 Answer | Asked in Insurance Bad Faith and Contracts for New York on
Q: Is an insurance company responsible for posting wrong information on Plan Summary document?

I received a dental service which is fully covered by my dental insurance, according to the Plan Summary document which my insurance company posted on the webpage. However, it turned out that the summary document was wrong, and it was not covered according to the full benefit document.

Is... View More

Tim Akpinar
Tim Akpinar
answered on Aug 16, 2023

You could make the argument that they are responsible for the incorrect information. They could respond with an argument that the long version policy applies, or that their post is subject to changes, or other provisions. If the denial is substantial, there are health care attorneys who litigate... View More

1 Answer | Asked in Insurance Bad Faith, Contracts and Family Law for New York on
Q: Regarding life insurance?

My dad had signed up for a term life insurance policy for $7000 until he reaches 90 years old, or when he dies. At the time when the insurance company called him to sign up he spoke very little English, that term was set to fully paid in 2013. But he kept paying the policy every month, he passed... View More

Tim Akpinar
Tim Akpinar
answered on Aug 13, 2023

I'm very sorry for the loss of your dad. One option is to try to arrange a brief consult with an attorney - it would be helpful to know the basis of the carrier's denial of a refund. It could be a matter of weighing the costs of litigating the potential refund against chances for a... View More

1 Answer | Asked in Health Care Law and Insurance Bad Faith for New York on
Q: What type of payment would an attorney need for a NY balance billing case (2021 DOS), ie hourly?

What payment structure does an attorney use for a balance billing case in New York by an in-network provider?

In network provider balance billed me though insurance EOB shows $0 owed as their claim from 2021 was discounted to $0. Provider's billing company refused to resubmit their... View More

Tim Akpinar
Tim Akpinar
answered on Apr 24, 2023

Attorneys who handle medical billing disputes apply various fee arrangements, depending on the type of insurance (no-fault, private, etc.), volume of claims (in terms of whether it's a high-volume institutional client, such as a large medical office or single-transaction individuals),... View More

1 Answer | Asked in Estate Planning, Insurance Bad Faith, Probate and Small Claims for New York on
Q: Grandfather died. My mother who was his listed as the beneficiary died 9 days after him? He had no will. What happens?

He has 3 other children who are full siblings to my mother. This is in Brooklyn NY, NYC.

Uncle says life insurance payout is on hold because they need my mother's death certificate.

Uncles not forthcoming with information and seem to be trying to get death certificate without me knowing.

Jack Mevorach
Jack Mevorach
answered on Oct 30, 2024

Listed as beneficiary where? For grandfather, if no will, estate passes by intestacy. Did you Mother have a will?

Jack

1 Answer | Asked in Insurance Bad Faith for New York on
Q: if I am the owner of a insurance policy for my mother, do I need to turn it in if she is going to receive medicaid
Tim Akpinar
Tim Akpinar
answered on Dec 5, 2023

This isn't an Insurance Bad Faith matter (the category where it is posted). You could repost and add "Elder Law" and "Health Care Law" as categories for better chances of a response - attorneys there could have the best insight into this. Good luck

1 Answer | Asked in Civil Rights and Insurance Bad Faith for New York on
Q: Is this illegal? Please note that I have disabilities.

Hi I just wanted to ask if it's legal or illegal for a health insurance company to deny a hospital claim just because you have secondary insurance. I reside in NY state if that matters

Tim Akpinar
Tim Akpinar
answered on Mar 29, 2023

It's difficult to comment whether there was an insurance law or policy violation without knowing the types of insurance, policy conditions, sequence in which hospital billed or otherwise coordinated the claims process between the two carriers. There are health care attorneys who handle billing... View More

1 Answer | Asked in Health Care Law and Insurance Bad Faith for New York on
Q: I was denied an MRI from Emblem health several times. New insurance now diagnosed with arthritis can I sue Emblem?

Emblem was my former insurance through my former employer. I suffer from hip pain. I was approved for an X-ray of my hip which showed normal. However the pain was severe. My PCP requested an MRI on my behalf several times, but Emblem denied the request each time. My coverage ended with Emblem on... View More

Tim Akpinar
Tim Akpinar
answered on Oct 5, 2022

I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated... View More

1 Answer | Asked in Insurance Bad Faith for New York on
Q: Can my old insurance charge me for medications they paid for after I lost coverage?

I am on a monthly medication paid for by my insurance, I switched jobs and thus got new insurance, but the pharmacy kept billing the old insurance.

The old insurance continued paying for my medications for 5 months. Now they're charging me a hefty ammount for the months they paid for... View More

Tim Akpinar
Tim Akpinar
answered on Apr 19, 2022

I'm sorry you find yourself at the end of a collection action with the medications. It's difficult to comment definitively on your position without seeing the terms of the policy and other paperwork. However, it sounds like they may be relying on the position that the patient has a... View More

1 Answer | Asked in Insurance Bad Faith and Insurance Defense for New York on
Q: Can i sue an insurance company

So my dilemma is I have a car accident reported on my car accident history last year. I have never been in an accident in my life. My mom got in an accident last may and i was in the car. She called me a week later and told me her insurance wanted to speak with me i explained the situation to them... View More

Tim Akpinar
Tim Akpinar
answered on Mar 12, 2022

Some elements of the scenario are not fully clear, but from the brief facts, it does not look like a case of insurance fraud. Insurance fraud cases generally involve deliberate conduct with the intent to deceive the other party. This looks more like it could be an administrative or communications... View More

1 Answer | Asked in Health Care Law, Insurance Bad Faith, Insurance Defense and Civil Rights for New York on
Q: Can a health care provider accept insurance based on merit of the patient?

A dentist office accepts my current insurance. But make me pay full price, bills my insurance separately then sends me a check for less than 50% of what I payed when my insurance covers 80% of the total visit. They also only make some people who have the same insurance pay. So if you and I both had... View More

Tim Akpinar
Tim Akpinar
answered on Feb 11, 2022

It could be difficult to speculate why a dental or medical office would apply different billing protocols. As a convenience to the patient, some offices do not bill patients but instead, have them complete paperwork enabling their billing staff or contractor to bill on patient's behalf. When... View More

1 Answer | Asked in Insurance Bad Faith and Insurance Defense for New York on
Q: Insurance company denied medically necessary breast reduction. My back is now more damaged. Can I sue?

Hi,

I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In... View More

Tim Akpinar
Tim Akpinar
answered on Dec 16, 2021

I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law... View More

2 Answers | Asked in Insurance Bad Faith, Personal Injury and Products Liability for New York on
Q: Why would a claims adjuster deny a claim and then turn around and want to offer payment for pain caused by the incident?

I am the third party in a product liability insurance claim. The claim was denied earlier this month and just yesterday, the adjuster called me wanting to "resolve" the claim by offering payment for "pain" from the injury.

Before the insured sent the complaint over to... View More

Jonathan R. Ratchik
Jonathan R. Ratchik
answered on Oct 4, 2021

When you state you're the "third party" I'm assuming you mean you're the claimant and not a third-party defendant. Regardless, as my colleague correctly advised, the claims adjuster's change in position can be due to many reasons. More likely than not, the adjuster... View More

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2 Answers | Asked in Personal Injury and Insurance Bad Faith for New York on
Q: How somebody can claim personal injuries in front of my house if there is no obstacles, potholes or cracked sidewalk?

If somebody claims that got hurt in front of my house how can request to be paid by my house liability insurance? My security system is old and cannot record, just view. Out of nowhere you just try to get money from your neighbors ?

Tim Akpinar
Tim Akpinar
answered on Sep 25, 2021

Your homeowner insurance company will thoroughly investigate the matter. It is not enough for someone to simply fall. They must show that it resulted from a defect in the surface or negligence on your part. The claims adjustor or defense attorney from your insurance company should be able to... View More

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1 Answer | Asked in Insurance Bad Faith for New York on
Q: Is it illegal for grandmother to keep insurance cards if I’m 19?

So I live with my grandmother. I’m 19 years old and moving out in august. She loves having control of everything! The thing is she has my insurance cards and refuses to give them to me. I’m going to need them when I move out. My college requires me to have my own insurance and I would like to... View More

Tim Akpinar
Tim Akpinar
answered on Jul 7, 2021

One option might be to contact the insurance carrier to request duplicate cards. Good luck

Tim Akpinar

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