Legal Question in Personal Injury in Arizona

Personal Injury

Can a ''not medically necessary'' defense by third-party insurance be asserted against an Diagnostic Testing Center? Radiologist do not assess medical necessity, they perform MRIs/diagnostic tests upon doctor's prescribed order. The third party insurance has denied payment for the MRIs. Any ideas on how to appeal based on law?


Asked on 12/02/08, 5:33 pm

1 Answer from Attorneys

James Jenkins Jenkins Law Center PLC

Re: Personal Injury

There is not enough information in your post to give a complete answer. It appears that you have an injury case, are not represented by an attorney, are trying to negotiate piece-meal, one issue at a time, with the insurance company for the at-fault person. You refer to the company as the "third party" carrier so that is the basis of my presumption.

The plaintiff in a personal injury case has the burden of proving that medical expenses are reasonable and necessary, but that is usually done with reports from a physician or hospital, if it is not readily apparent from a layman point of view. You could get a report from the doctor that the procedure was necessary due to injuries from the accident.

See an accident attorney. Present all details and documents for a proper opinion. Get an attorney to represent you in this matter. Do not take a posture of standing with your hat in your hand begging an insurance company to pay for something. Get legal advice from an attorney, and representation.

Good luck.

James D. Jenkins

Disclaimer: This post is not intended as specific legal advice in a particular case, and is given for general educational purposes only, and is not intended to create any attorney-client relationship. See your own attorney for legal advice in your particular case.

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Answered on 12/02/08, 7:14 pm


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