Keeping Your No-Fault Benefits after a Traffic Accident

If you’ve been injured in a traffic accident, your medical bills are usually paid by your car insurance.  This benefit is commonly referred to as a “no-fault” benefit, as you are entitled to this coverage regardless of how the accident happened.  This covers drivers, passengers and pedestrians that are involved in traffic accidents unless the accident happened while the person was working.  It’s important to note that health insurance will not cover medical bills from traffic accidents, the no-fault benefits are primary.

If you are eligible (the accident didn’t happen while you were working,) no-fault will pay the bills for any ambulance and emergency room treatment resulting from a traffic accident.  If you require further treatment, you must treat with a medical provider that accepts “no-fault” insurance. It is fairly easy to find a chiropractor or physical therapist that accepts no-fault, but more difficult to find specialists such as orthopedists and neurologists that accept this coverage.  Your attorney can often help you find quality providers that accept no-fault.

Independent Medical Examinations

After you have been treating for a while, the insurance company will schedule what they call “Independent Medical Examinations.”  It is mandatory that you attend these appointments, as failure to do so can result in the insurance company refusing to pay any of your medical bills, leaving you owing the money to the providers.  The insurance company will usually allow you to reschedule these appointments once, but if you miss the second appointment, they can be very strict with refusing to provide a third opportunity.

These Independent Medical Examinations (IME”S) are conducted by doctors hired by the insurance company, and the purpose of the examination is to find a way to say that you are recovered and don’t need any further treatment.  It is important that you come to these appointment with all relevant medical records, especially reports from doctors that indicate the severity of your injuries or your need for surgery. Be sure to complain about everything that is bothering you, but don’t ham it up, they can see through that!  You won’t have much time for a performance anyway, as these exams are usually only about five minutes long!

If the doctor the insurance company hired for the IME writes a report indicating that you have “reached maximum benefit” from treatment, you will receive a “no-fault” cut-off notice indicating that your benefits are over and that the insurance company will not be paying for any further treatment.  This happens so often, and the IME’s are so hastily done, that many doctors hire attorneys to arbitrate these denials, and usually they win. As a result, many doctors that accept no-fault are willing to treat patients after the no-fault cut-off, and wait to get paid when the attorneys win the arbitrations contesting the cut-offs.  It’s a good idea to treat with medical providers that are willing to treat you after the cut-off, as you will have the opportunity to get more treatment.

If you have any questions, please feel free to call us at 718-261-8114.  We’ll answer all your questions, and address all your concerns!