You were hurt in a motor vehicle accident and filed for No-Fault benefits. What happens next? What kind of treatment is covered? Where do you go for treatment? And perhaps the biggest question, who pays for your medical treatment?
Here is a list of medical expenses covered under No-Fault:
- Medical (examples: primary care physician, orthopedic surgeon)
- Prosthetic services
- Physical therapy (must have a referral)
- Occupational therapy
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What Do I Tell My Medical Providers Upon Visiting After a No-Fault Accident?
Make sure you inform your medical providers (whether it be a hospital, doctor’s office, chiropractor, etc) that you are there because you were hurt in a car accident. The medical provider will then bill the no-fault insurance company directly. This is especially important if the provider is one you normally treat with – you don’t want them billing your health insurance company by mistake.
If you have to fill out forms at the provider’s office concerning your accident, remember – anything you write can be used against you later – it is best to provide only a general description of the accident. For example: “multi-motor vehicle accident”; “one-car accident.”
Also, be prepared to tell your health care provider what your exact physical ailments are and what is bothering you – don’t leave anything out, because even if you have details at the back of your mind that you think may not be significant, the provider may think otherwise. The most important thing to remember is that to get the best possible treatment for the injuries you suffered, you need to be extremely thorough when telling your doctor about the injuries you sustained in your accident. Getting well should be your top priority.
How Does No-Fault Insurance Work Once I Start Treatment?
At some point, after you begin treating, the no-fault insurance company will seek to “verify” your injuries. To be blunt, the no-fault insurance company wants to show that you are not injured so they can stop paying for medical expenses, lost earnings, and other expenses. Remember, the no-fault insurance company must provide up to $50,000 in protection. However, this requirement does not mean they must pay out $50,000 worth of coverage.
In order to “verify” that you are injured, the no-fault insurance company may send you to one of their own doctors for an “Independent Medical Examination” or “IME.” You MUST attend the IME if one is scheduled – if you “no show” two times, the no-fault insurance company may retroactively deny benefits (meaning, deny all benefits from the date of the accident onward!). Appearing for the appointment is the first step, so do not ruin your chances of having your regular treatments with your own providers covered because you missed your IME.
It is important to realize that the doctor who performs the IME essentially works for the no-fault insurance company. More often than not, after this IME, your benefits will be cut off because the “independent” doctor will claim you are not as injured as you, or even your doctors, say. Even though this sounds incredibly wrong, especially as the final judgment would be coming from a doctor, it does happen and so it is important to prepare yourself for this outcome.
Another way the no-fault insurance company “verifies” your injuries is to take your testimony at an “examination under oath” or “EUO.” You will be sworn to tell the truth and will be asked questions by the no-fault insurance company. Often, a stenographer will also be present to take down everything that is said. In these situations, patients can sometimes say the wrong thing because they are nervous about the possibility of losing the benefits they need, which is why It is best if you have an attorney representing you at this point to make sure that your rights are protected. As with the “IME”, if you “no show,” the no-fault insurance company can retroactively deny benefits.
You Were Denied Coverage – What Now?
What do you do if and when the no-fault insurance company denies any more treatment? As said earlier, more often than not, this is what occurs after the IME or EUO. If you still need medical treatment, which may very well be the case if your accident was serious and left you with substantial injuries, you may continue to receive treatment; however, no-fault will no longer pay your doctors’ bills. If you have health insurance, tell your doctors to start to bill your health insurance instead of no-fault. Your doctors will also ask for insurance information – they want to be paid and if no-fault isn’t paying, they want to know who they should bill.
If you do not have health insurance, and no-fault has denied your claims, sometimes medical providers will agree to be paid out of the money you may receive from a settlement. This is considered a lien. An attorney should review any lien documents, again to protect your rights.
As previously stated in the above paragraphs, the most important thing to do if you’ve been hurt in an accident is to make sure you get good medical care so that the injuries you sustained in your accident do not follow you through the rest of your life. Seek medical treatment immediately and follow through with your doctors’ recommendations.
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Call a Long Island Personal Injury Attorney Today
If you have been in an accident and the No-Fault insurance company with whom you have filed a claim is refusing to pay for your medical treatments, call one of our personal injury attorneys today. We have dealt with for years cases concerning these types of insurance companies, and we have found that they will do almost anything to avoid paying what they should. Do not let your injuries go untreated because you cannot pay for medical care. Whether you are in Suffolk County or Nassau County, contact us and let us help you get the coverage that you seek.