Personal Injury Law

New York No-Fault Law--What You Need To Know--Part 1

By Mark Siesel, Esq.

In New York State, if you are injured in a motor vehicle accident, regardless of which car is at fault for the accident, your medical expenses and lost earnings will be paid by your own insurance company under the No-Fault Law of New York State. In order to qualify for no-fault benefits, you must immediately report the accident to your insurance company, and then you must submit what is known as an NF-2 (No-Fault Report Of Accident) within 30 days of the New York car crash. This 30 day rule is a problem, in that clients frequently are unfamiliar with the rule and don't initially intend to pursue a claim for their injuries. When they do contact a lawyer and learn that their medical bills, lost earnings and expenses are supposed to be submitted to their own insurance company (Clients will often ask-"Why is my insurance company responsible--that guy rear ended me!") it is often past the 30 day window, and the client's insurance company can attempt to disclaim coverage for no-fault benefits.

Once the claim has been properly filed with the no-fault insurance company, it is vital to obtain as much treatment with the orthopedist, neurologist, physical therapist, chiropractor or other provider as soon as possible. The reason for this is that all insurance companies will send you for an "Independent Medical Examination" (IME) within several weeks of the commencement of treatment, and in some cases, within days, to determine whether you need medical treatment. Of course, the "Independent" medical examiner, is anything but, often conducting 30 or more of these exams in one day. Certainly, it doesn't take a big stretch to say that they "know where their bread is buttered", and they are not likely to remain on the approved list of the insurance company if they continuously find that the examinee is in need of further treatment. It is my estimate that in 90% of our client's cases, the first examination with the "IME" doctor is used to establish that the client does not meet the No-Fault threshold" of "serious injury", and thus, the client is cut off from further treatment with that specialist. Insurance companies will often schedule numerous examinations for a client at the same time--i.e- they are sent to a neurologist, orthopedist and a chiropractor on the same day, so that the insurance company can utilize these "normal" examinations to cut the client off from all benefits.

Thus, it is our recommendation to our clients that they seek all necessary medical treatment expeditiously, not miss any appointments if at all possible, and when undergoing an "IME", explain to the doctor in detail the benefit they are receiving from their treatment (obviously, if you inform the no-fault doctor that treatment is not providing any benefit, you will be cut off). We find that if the client is upfront and respectful of the no-fault examiner, but also makes definitively clear that they do need more treatment and that the treatment is having some positive effect, the client may at least obtain one additional course of treatment of 6 to 8 weeks. This extension is vital to the personal injury aspect of the New York car crash case, as we will discuss in Part 2 of this post.

Full post as published by New York Legal Blog on April 02, 2010 (boomark / email).