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Great No-Fault Result for Dave Tetlak and the No-Fault Team

June 13, 2016
By: Frank Scahill

Congratulations to Dave Tetlak and our No-Fault Team for a great result on an ATIC arbitration. The amount demand demanded, $80,994.83, was denied in its entirety. The relevant portion of the decision is below:

The only other relevant evidence with respect to the question of the timeliness of the bill is the "proof of mailing" referred to by the billing manager. The ECF contains a heavily redacted log sheet that bears a US Postal Service post mark of 3/2/15. I note that the billing manager, Mike Manzo, swore in his affidavit that he personally maintains the logbook and that all claims are mailed on the first business day of each week. 3/2/15 was in fact a Monday. 4/17/15 was a Thursday. The post marked page of the log book that was submitted was redacted so that only the fourth entry on the page is legible. The column on the far left of the page is headed "article number" and the visible entry in that column has the relevant information necessary to identify the claim that is the subject of this arbitration. However, the second column, headed "Addressee (Name, Street, City, State & Zip Code)", has the Respondent's name and address in totally different handwriting than that identifying the claim. I also note that the second column has ruled lines on which to write the addressee's information. However, on the single section of the log that is visible the first column, again in obviously different handwriting than the second, is not lined, at least suggesting the possibility that the entry was whited out and rewritten.

I find that absent a direct affidavit of mailing, the discrepancy in the handwriting and the appearance that the claim information may have been added, particularly in view of the fact that the remainder of the log page is redacted so that no comparison to other entries of that day could be made, the log itself lacks credibility and is insufficient to establish timely mailing of the bill in issue. Although not required, I find the failure of theApplicant to attempt to justify its late bill directly prior to filing for arbitration further calls the actions of the billing company into question. I find nothing in the telephone call of 4/17/15 to indicate that a bill was actually mailed prior to that phone call. I note that the degree of redaction was completely unnecessary to preserve patient confidentiality insofar as the only necessary redaction for each entry would be the patient's name and file/claim number. There was no reason whatsoever to redact any portion of the column listing addressees. I find that these overly extensive redactions render the log virtually useless in establishing mailing on 3/2/15. As such, I find that the Applicant is not entitled to any reimbursement due to having submitted its bill in excess of forty-five days after the services reflected in the bill were rendered and find that the remaining unaddressed issues are therefore moot.

Read the complete decision here.

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