Legal Question in Insurance Law in New York

Re: Medical Necessity Appeal

The most appropriate resoponse to a denial on the grounds of lack of medical necessity is to show that there is a medical necessity arising from the accident; perhaps the company's own MD will have said things that conflict, or if there is more than one, they will contradict each other.

Absent that type of challenge, you need your own treating MD to write a narrative letter with his diagnisis and conclusisons, which may cost you something. Possibly the doctor would be willing to testify by telephone if permitted by the arbitrator. Point out that your Doctor is not hired to give an opinion.

A challenge for arbitrary and capriciousness means just that; the decision is wrong because it makes no sense, and is not based on the evidence. I prefer not to challenge the arbitrator unless there is an obvious bias, in which case he should have recused himself.