WHAT IS NO FAULT INSURANCE?
When you are injured in an automobile accident you never think your most difficult fight will be with your own insurance company. No Fault insurance is part of your automobile insurance policy that provides coverage to pay for specific expenses incurred by you, your family, and any passenger in your vehicle. No Fault insurance covers such expenses as medical bills, lost wages, and certain other expenses, including travel to medical providers, home assistance, and medical devices. Although this coverage is provided by your own insurance company for your benefit, the carrier will often seek to terminate your benefit before you and your doctors agree that you have made a full recovery. In order to protect your rights, you need knowledgeable and experienced legal counsel that will make sure that your carrier pays all of the benefits to which you are entitled. At Kommer, Bave & Ollman LLP we have an experienced staff of attorneys and paralegals that review your No Fault claim to identify any coverage to which you are entitled. Once the No Fault application is submitted, our staff will assist you in insuring that you receive the maximum benefits payable under your policy. We recognize the importance of having these benefits paid during the entire time that you are disabled or require medical treatment, no just the time the insurance company considers to be reasonable.
The minimum basic No Fault policy limit is $50,000.00. This means that your No Fault carrier will pay to you, or a covered person, medical bills, lost wages, and other covered expenses up to a limit of $50,000.00. Many people choose to purchase additional coverage but every New York policy requires minimum benefits of $50,000.00. In order to qualify for No Fault benefits, you must submit a signed application to the insurance carrier within thirty (30) days of the date of loss, and your failure to do so can result in a denial of your No Fault claim. This is an important step and if you intend to make a claim, the application should be reviewed by an experienced attorney to insure that the application is submitted in proper form to any carrier for which coverage may exist.
After the application is submitted to the carrier, all bills incurred for medical treatment, transportation, and assistive devices must be submitted to the No Fault carrier within forty-five(45) days or payment will denied. It is important that all bills be submitted to the No Fault carrier and not to your regular insurance carrier or Medicare. If bills are submitted to your regular health insurance carrier or to Medicare, those entities will assert a lien which you are required to repay from the proceeds of your claim or lawsuit. If you make a recovery from a from a negligent party in a claim or lawsuit, the amount you receive will be reduced by the amount due to your regular health insurance carrier or Medicare for the amount that they paid in your behalf. Medical bills can be very substantial and can even exceed the amount that you recover from a negligent party.
No fault insurance does not pay your medical bills or lost wages forever. Lost wages are only payable for a period of three years or until you are able to return to work. Likewise, medical bills will be paid so long as your benefits have not been exhausted and there is a medical necessity for the treatment. Generally, within ninety (90) days of the date of your injury, you will be notified by your carrier of an Aindependent medical exam@ you will be required to attend an independent medical exam which will be conducted by a physician designated by your carrier. These examinations are often completed in a matter of minutes but the impact upon you can be tremendous. The insurance company=s doctors perform a brief examination and then decide whether you are disabled and require any additional treatment. If the doctor feels you have recovered, your benefits will be terminated and they will refuse to pay for any additional medical bills from the specialty for which you were examined. If they feel that you are no longer disabled, your lost wage benefits will be terminated even if you and your own doctors feel that you are unable to return to work. Obviously, the impact of these examinations can a dramatic effect upon your treatment and supporting your family as you recover from your injuries.
Often a disagreement arises as a result of the independent medical examination performed by the No Fault physician. You may disagree with the doctor that says you are not longer disabled and that you are able to return to work. Perhaps your pain has increased and causes you to be disabled but it is not sufficient to prevent you from standing, walking, or sitting for short periods of time. If you and your doctors disagree with the No Fault carrier=s decision to terminate benefits, you have certain limited rights. It is important that you have the advantage of experienced attorneys and staff that can advise you as to the options that are available to you when you receive a Denial Of Benefits. Think of the consequences if you are disabled and unable to work and your only means of support are your No Fault benefits which are unilaterally terminated based upon the No Fault doctor=s recommendation. The consequences can be terrible for you and your family unless you take immediate action to insure that the benefits are restored or otherwise continued.