Arbitration Statistics for 03/04/10

There were 61 arbitration awards issued yesterday, March 4, 2010.  One can search through these awards on the AAA website by  selecting from a number of categories listed alphabetically in a box labeled “no fault case issues.”

Evidently, each arbitration award is “tagged” with at least one issue.  Yesterday for example, there were 198 issues “tagged” for 61 cases, meaning that on average, each arbitration is tagged with three issues.

The issues roughly break down into two categories, “Types of Claims” and “Reasons for Denial.”  Clearly many cases will involve more than one type of claim (an MRI and surgery for example) or more than one reason for denial (fee schedule and IME for example), thus accounting for how each case generally carries around three issues.

Unfortunately, the search results page does not lend itself very well to easy viewing of awards by issue and outcome.  So here is a breakdown of the most arbitrated types of claims and most arbitrated reasons for denial.  Following each reason is a breakdown of the outcome of the arbitration that include that denial reason.

Type of Claim

Office visit/Consultation – 21
Nerve Testing – 15
Physical Medicine – 10
Chiro treatment – 9
MRI – 8
Medical Supplies – 7
Acupuncture – 6
PT – 3
Range of motion/muscle testing – 3
Surgery – 3
X-rays/radiological procedures – 3
Pharmaceuticals – 2
Biofeedback – 1
Lost earnings – 1
Massage Therapy – 1
Psychiatry/Psychology – 1

Reason for Denial

Fees not in accordance with fee schedules – 34 (Full Award – 11, Partial Award – 13, Denied/Dismissed – 10)
Negative IME – 21 (7/8/6)
Bill not denied, carrier delayed for lack of verification – 13 (9/0/4)
Denied based on peer review – 13 (6/5/2)
No Show for IME/EUO – 6 (1/2/3)
Policy violation – 5 (1/1/3)
Excessive treatment – 4 (0/3/1)
Carrier alleges fraud – 2 (1/0/1)
Claimed loss allegedly not proven – 2 (1/0/1)
No response from carrier – 2 (2/0/0)
Failure to provide requested documentation – 1 (1/0/0)
No coverage on policy – 1 (0/0/1)