What is No-Fault?
All insurance companies issuing automobile insurance policies in the State of New York are required to provide no-fault coverage for the occupants of the vehicle in the event of an accident. If you were a pedestrian or bicyclist hit by a vehicle, you would be covered under the no-fault insurance policy of the vehicle that hit you. The policy must provide at least $50,000 in no-fault protection for each Claimant, but can provide additional coverage should the policy holder elect to pay an additional premium for the increase in coverage.
No-fault insurance covers medical bills and lost wages, among other expenses. In other words, regardless of whose fault the accident was, your medical bills are paid for by the no-fault insurance company up to the policy limit. If you lose time from work as a result of the accident, the no-fault insurance company’s policy will cover your lost wages, but only up to the limits specified therein and for a defined duration (usually three years). In addition, the policy may allow you to collect for other reasonable and necessary expenses incurred, which is usually up to $25 per day unless additional coverage was purchased by the policy holder.
To determine your eligibility for benefits and what you’re entitled to collect, look to the insurance policy and Declaration page under the “no-fault” section. The Declarations page will reveal the amount of coverage that is available to you for medical treatment, lost earnings and other expenses. If your lost wages, medical bills or other expenses exceed the no-fault limit, you may be entitled to recover the excess in a personal injury lawsuit.
Are There Time Limits or Deadlines Regarding No-Fault?
The answer is YES! The applicable no-fault carrier must be put on written notice within thirty (30) days of the accident. If they are not put on timely notice, they may deny your claims for medical expenses, lost wages and other expenses.
What is an “IME”?
“IME” is the acronym for Independent Medical Examination. Some time after you have treated for your car accident injuries, the insurance company paying your medical bills will send written notice requiring you to attend an IME. This is a medical examination performed by a doctor paid by the insurance company. The purpose of the IME is for the insurance company doctor to make a determination as to whether or not you need further treatment. The waiting rooms in these doctor’s offices are usually jam-packed by numerous other people receiving no-fault benefits who are scheduled and waiting to be examined by one doctor.
The IME doctor hired by the insurance company that examines you often rushes through the exam and acts like you’re really not hurt, and then sends a report to the insurance company giving his medical opinion as to the extent of your injury, if any. If the IME doctor issues a determination that you do not need any further treatment, your insurance company will stop paying for further medical treatment and will cut-off paying for your lost wages if the IME doctor determines that you are able to return to work.
But even if the IME doctor issues a report indicating that no further treatment is necessary, you can still continue treating if your doctor advises it. Your doctor can either arbitrate the bill for payment against the insurance company or may ask your lawyer to sign a “lien letter.” If your attorney signs a lien letter, then when your personal injury case is resolved, unpaid bills will be paid from the personal injury settlement. Your attorney may be able to negotiate these bills with your physician upon the conclusion of the case.
Is Everyone covered by No-Fault?
Motorcyclists, as well as their passengers, are not covered under New York no-fault.
If you are injured as a result of someone else’s negligence, contact Manhattan Car Accident Lawyer Michael J. Redenburg, Esq. at 212-518-2095.