New York's highest court of appeals has held that no-fault insurers cannot deny no-fault benefits where they unilaterally determine that a provider has committed misconduct based upon alleged fraudulent conduct. The Court held that this authority belongs solely to state regulators, specifically New York's Board of Regents, which oversees professional licensing and discipline. This follows a similar recent ruling in Florida reported in this publication.
IQ (Interesting Quote)
"Physicians predicted a 'great improvement' of quality of life after surgery for 79% and 'moderate' improvement for 20% ... despite clear average improvement, surgeons tended to give overly optimistic predictions that were not correlated with patient outcome at 1-year follow-up."
- Results from a recent study comparing physician predictions with outcomes for patients undergoing surgery for low back pain and sciatica. According to the study, 56% of patients whose surgeons predicted "a great deal of improvement" reported no significant improvement in their health one year after surgery.
SOURCE: Graz B, Wietlisbach V, et al. Prognosis or "curabo effect?" Physician prediction and patient outcome of surgery for low back pain and sciatica. Spine, June 15, 2005;30(12):1448-52.