No-Fault Benefits (Part 2 – Medical Treatment)

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?  Who pays?

Here is a list of medical expenses covered under No-Fault:

  • Hospital
  • Medical (examples: primary care physician, orthopedic surgeon)
  • Surgical
  • Dental
  • Ambulance
  • X-ray
  • Prescriptions
  • Prosthetic services
  • Psychiatric
  • Physical therapy (must have referral)
  • Occupational therapy
  • Rehabilitation
  • Acupuncture

Make sure you tell 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 is bothering you – don’t leave anything out, even if you think it may not be significant, the provider may think otherwise.  The most important thing to remember – get good treatment for the injuries you suffered.  Getting well should be your top priority.

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.  This requirement does not mean they must pay out $50,000 worth of coverage.

In order to “verify” that you’re 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!).

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.

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.  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.

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, 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 said earlier, the most important thing to do if you’ve been hurt in an accident is to make sure you get good medical care.  Seek medical treatment immediately and follow through with your doctors’ recommendations.

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Check out the whole Series:

No-Fault Benefits (Part 1 – Overview)

No-Fault Benefits (Part 2 – Medical Treatment)  — Current

No-Fault Benefits (Part 3 – Lost Wages)

No-Fault Benefits (Part 4 – APIP and OBEL)

No-Fault Benefits (Part 5 – Denial of Benefits)