Atorney succeeded in the National Arbitration Forum
Atorney succeeded in the National Arbitration Forum. Following a binding arbitration hearing, the arbitrator found in favor of defendant insurance company with regard to the medical providers' Demand for Arbitration seeking reimbursement of Personal Injury Protection Benefits because the medical provider failed to prove by a preponderance of the evidence that the initial office visit met the requirements of CPT Code 99245. Additionally, the medical provider failed to demonstrate clinically supported findings that revealed a loss of sensation and numbness, thus the arbitrator found that the EMG/NCV testing to the insured's upper extremities was not medical necessary. As such, the arbitrator held that the medical provider was not entitled to reimbursement for these services.