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

You were hurt in a motor vehicle accident and filed for No-Fault benefits.  You have treated with various doctors and therapists for your injuries. As mentioned in an earlier blog (Part 2), the no-fault carrier will likely “verify” your injuries.  In doing so, you may be required to appear for a so-called independent medical examination (IME).  An examination under oath (EUO) may also be demanded by the insurance company.  More often, the no-fault carrier will seek to have you examined by one or more of their physicians at an IME.


You must appear for the IME and/or EUO.  If you fail to appear (or no-show), your no-fault benefits may be retroactively denied (meaning, all benefits from the date of the accident onward!).  Do not make it easy for the no-fault carrier to deny your benefits – DO NOT MISS IME or EUO appointments!  If the appointment the insurance company sets up is inconvenient, you may contact them and reschedule.


Even if you do appear at the IME, the no-fault carrier’s doctor may determine that you are not as injured as you, and your doctors, say you are.  In that case, some or all of your benefits may be denied. 


For instance, if you treat with a physical therapist and an acupuncturist, the no-fault carrier’s IME doctor may find that you need only one physical therapy visit per week (as opposed to the three visits recommended by your doctor) and that you don’t need acupuncture at all.  In that case, No-Fault will stop paying for acupuncture and will only pay for physical therapy once per week.  If you still want to treat with an acupuncturist, you will have to pay for the visits yourself or have the visits billed to your personal health insurance, if that is an option. 


Sometimes, the no-fault carrier’s IME doctor will find that you don’t need any further medical treatment – from any medical provider.  In that instance, you, your lawyer and your doctors or other medical providers will be given notice that your medical benefits have been terminated as of a certain date.  Any treatment you receive after that date certain you will be responsible for, unless you have health insurance.  If you have health insurance and have received a No-Fault denial of benefits, ask your medical provider (doctor, therapist, etc) to bill your health insurance carrier for your continued treatment. 


Once again, and it bears repeating, 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, follow through with your doctors’ recommendations and, if at all possible, continue to follow the recommendations of your own health care providers, even after you’ve received a no-fault denial. 


Check out the whole Series:

No-Fault Benefits (Part 1 – Overview)

No-Fault Benefits (Part 2 – Medical Treatment)

No-Fault Benefits (Part 3 – Lost Wages)

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

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