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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.

No Fault Arbitration for an Accident or Injury in Minnesota

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 should 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.









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