Nicole R. Cassata successfully defended a Forthright Appeal against Meadowlands Hospital, which had sought to overturn the denial of a $245,045.96 claim in the matter of Meadowlands Hospital a/s/o J.F. v. New Jersey Manufacturers Insurance Company, (Forthright No., 1671100).  In the Appeal, Claimant argued that the Dispute Resolution Professional in the underlying Award made a mistake of law when she determined that Claimant’s bills were subject to a usual, customary and reasonable analysis even if the service provided represented an “inpatient” stay. Claimant argued they were entitled to the billed amounts and that a UCR analysis was not appropriate pursuant to N.J.A.C. 11:3-29.1(d)(4). On Appeal, Nicole argued that the DRP did not commit an error or mistake of law and that she appropriately applied a UCR analysis to the bills at issue. She argued that claimant’s position was contrary to the entire purpose and scheme of the Automobile Insurance Cost Reduction Act (“AICRA”) and that N.J.A.C. 11:3-29.4(e) never requires an insurance carrier to pay more than the fee schedule or the usual, customary and reasonable fee.  The Forthright Appeal Panel agreed, unanimously holding that there was no evidence that the DRP exceeded her power or imperfectly executed that power, or committed a mistake of law or fact.  The underlying no cause in NJM’s favor was affirmed in its entirety. 

Chasan Lamparello
Mallon & Cappuzzo, PC

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