0 Replies Latest reply: Sep 10, 2017 11:03 AM by Martin Schulman

Modria format and possible improvements

Martin Schulman
Visibility: Open to anyone

In a recent posting under a different heading there was the suggestion that the nature of the Modria format itself created the need for Arbitrators to expend unreasonably amounts of time to evaluate and address the issues presented. I would like to present my own experience with an alternative.

In early summer I was involved in an effort to expeditiously deal with low dollar claims on submissions without the need for attorneys to be present. In connection with that effort, which involved two days of hearings, thirty six cases, I suggested what I thought would be a streamlined format within which the litigants would have been required to present their claims. Unfortunately due to time and presentation requirements the format was only used on one of the hearing days and I was thoroughly happy with the way it effectively reduced the amount of time required to prepare myself for the hearing. At the same time I found it did not in any way diminish my ability to understand the entirety of the litigants presentations.

The format, which was circulated to all litigants with the cooperation of Fran Ciringione is as follows:


     "Submissions should be limited, as I will set forth, with no additions, late submissions, addenda or final thoughts permitted and conform, more or less, to the following form:


     1. Statement of fact including the nature of the services involved giving specifics, not CPT code numbers and basis of denial.      (No more than two paragraphs).


     2. How much is in dispute and how was that amount arrived at, i.e., what was billed, what was paid and what is left over      (disputed amount).


     3. Submission of NF 3, NF 10 and any other mandated forms that were exchanged by the parties.


     4. Copy of Peer review or IME and rebuttal or post benefits medical narratives. No addenda, afterthoughts or check off forms.


     5. Memorandum of law of no more than one page with citations in support or opposition to adversary's point of view."



The best I can do to describe the results of the use of the format is to present the copy of a letter I sent to the AAA on August 2, 2017:


    "Apart from any other outstanding issues I wanted to share information relating to the questions and template Francesca      sent to the litigants in the 8/4 hearings. My new document submissions were full of the responses this morning and I invite      you to inspect the results.


     These responses are better than I could have imagined in defining the issues, delineating the evidence and succinctly stating      the litigants position in the arbitration. While I have not gone through them all, there were sixteen new submissions on my      Modria this morning, the ones reviewed were focused and will be quite helpful in evaluating the parties' positions in the      litigation (notwithstanding the fact that by now I have already reviewed all the cases and made outlines of possible      ecisions).


     I think that the format I proposed and which you cooperated with  has the possibility, if the existing format is intelligently      parsed, of allowing an Arbitrator to get all the information necessary in connection with these low dollar cases, sharply           reduce the time needed to evaluation and come to a conclusion and eliminate a tremendous amount of superfluous      information and "Fat" in the submissions. As a result the Arbitrator saves time, the AAA has a smaller administrative burden      and the litigants get quick, focused decisions.


     I also want to thank you for trying out my suggestions."

Unfortunately I never received a response to that letter and no further action on the suggested format took place.