BRINGING THE NO-FAULT CLAIM
REPRESENTING THE PLAINTIFF IN NO-FAULT HEARINGS
By Michael A. Bryant
The representation of a client can have very interesting consequences which
work in a dichotomy between strong representation and working with the
defendant’s insurance company/claimant’s no-fault company in order to get
benefits paid. Different companies, adjusters and the client’s circumstances can
weigh heavily on how much to cooperate and what action needs to be taken in
order to get bills paid.
The results of a no-fault arbitration can be, for many clients, even more important
than how the third party case turns out. It is the ongoing bills and the subtle
pressures from the medical providers that seem to stress your client out more
than anything. Those people who come into your office saying what they really
want is to get their bills paid and are not getting that result. Technically, waiting to
do the no-fault arbitration may have litigation advantages and create a weightier
issue to be argued over. But, claims for a smaller amount have a greater chance
of success and are often responded to by the insurance company with a payment
despite the opinion of the adverse.
WHEN TO FILE?
It tends to be my policy to file soon after benefits are denied or if they are not
getting paid after 30 days. There are a number of benefits gained by quick filings:
1. The amount that is being arbitrated is smaller and you have a better direct
comparison to the client’s condition a short time after the actual cut off. The
simple AAA process, filing, selecting arbitrators and getting an arbitration date is
going to eat up a significant amount of time. Consequently, sooner is better than
later.
2. There are no longer any issues concerning estoppel.
3. Your client gets an opportunity to see you as a "real" lawyer. Overall, the
clients get so few opportunities to actually see us do our job. It is amazing how
the simple opportunity of seeing you do your job at a no -fault arbitration will help
in advising your client in the future. The hearing will also give you a solid
understanding of the overall case. This helps with whatever additional items are
brought up by the defense and gives you a chance to review the ability of your
client to testify on their own behalf.
ARBITRATOR STRIKE LIST
Many times you will know a majority of the people on the list. If you do not, you
can contact AAA and other attorneys to find out more information about each
arbitrator. Concerning the actual appointment of arbitrators, it is my
understanding that AAA adds numbers and picks the lowest total number of the
arbitrators that have not been struck. Consequently, at times, there may be
reasons to put an obvious second choice in as first in order to help with that
mathematical selection.
Once the arbitrator is selected, you get an opportunity to review his/her
disclosure and decide whether or not the client needs to look at any possibilities
for objections or should know anything about the individual arbitrator. Also,
working in a smaller community, I have run the name by the client as soon as
possible in order to make sure there is not a conflict that was previously not
recognized.
DISCOVERY
Under the AAA rules, formal discovery is discouraged. Typically, I send a Rule 12
request which asks if the Respondents will have any witnesses, what exhibits
they will be offering at the hearing, all medical records in their possession and
any supporting documentation defined in Rule 5 (f). In response to their
discovery, I stick to the Rule 12 requirements providing the Respondents with
relevant authorizations and notifying them that we will be providing a Statement
of Case prior to the hearing which will include medical records, reports and
exhibits.
PREPARING FOR THE ARBITRATION
Typically, the Claimant’s brief is dictated about three weeks before the
arbitration. It is important to make sure the brief is delivered to the arbitrator prior
to the hearing. It is also important that you give enough time to meet with the
client and to cover the issues of the arbitration. Some people will meet their client
a day before the hearing. I often meet with my client two full hours before the
arbitration in order to ensure that we can go through the issues of the arbitration.
In meeting with the client, you sho uld review what is being requested and what
the standards are for the arbitration. In particular, the practitioner should review
the elements for the standard of reasonable (there is very little the client can do
about that because it is about the bills of the treating providers), necessary (that
the client has needed the care and that the client should explain why they need
the care) and related (the client can explain the difference in their condition since
the accident). It is also very important to review what it is you believe the defense
will ask. If, as often happens, the defense shows up with their brief at the
beginning of the arbitration, time should be requested from the arbitrator to
review the book and cover any additional items with the client. It is necessary
that the client have an understanding of what prior issues are going to be asked
about and questions regarding that prior care. In some arbitrations, it has gotten
to the point where you almost have to review with the client what actually
happened at each visit so the client can answer those questions.
During the actual arbitration, the testimony should be centered around the
reasonable, necessary and related standards. All necessary foundational issues
should be covered in order to set up the closing argument. In many cases, a
typical direct should not take more than five to ten minutes. It is essential to stick
to the areas of the law related to reasonable, necessary and related and stay
away from the areas that are irrelevant in a AAA arbitration. By doing this, there
is not a lot that needs to be asked.
I would submit that money that is lost at arbitrations boils down to one of the
following:
1. Ill prepared counsel and/or client.
2. Lack of evidence at the arbitration.
3. Not putting the time into the brief to ensure victory.
CONCLUSION
Overall, no-fault hearings are very important to clients because they involve their
bills. Many people come to you only because they want to get their bills paid.
Often you wonder if many third party claims would be prevented if no-fault
companies took better care of their own insureds. Not having their bills paid is
scary for each client as they look at the possibility of having to pay the bills
themselves. It is important to take the time at the no-fault hearing to provide the
arbitrator everything that the arbitrator needs to make a sound decision and to
present your client in a manner that gives you the best chance at success.
The no-fault arbitrations are out there to be won. With a good system in place
and appropriate attention to detail, that will happen. Even with the large number
of no-fault arbitrations handled by our office over the last ten years, we are still
down to only a handful of zeros. Despite being able to remember the arbitrator
and the cases attached to each of these zeros, sometimes there is very little you
can do about it. It has been said that one complaining client will have ten times
the effect of one happy client. Winning the no -fault arbitrations has led to the
chorus of happy clients and medical providers.
