The biggest concern a person will likely have to deal with after sustaining an injury in a motor vehicle accident are medical bills. Just a routine examination in a hospital emergency room following an accident can cost several thousand dollars. If you need to undergo any additional treatment the bills can be astronomical.
New York is a no-fault state. Therefore, you will be qualified immediately following your accident for no-fault benefits. Further, since New York is a no-fault state your car insurance coverage will be your primary source of insurance coverage for your medical treatment. This means that all medical bills must be submitted to the no-fault carrier for payment. Any bills submitted to your private health insurance will be denied if no-fault insurance is available to you.
The only exception to this rule is if you are in a motor vehicle accident while at work. For example, if you are making a delivery for your job and are rear-ended. In a scenario where you are injured during the course of your employment, workers compensation insurance will become the primary insurance policy and no-fault will be secondary. However, if you are on your way to work or on your way home from work and off the clock, no-fault will still be your primary insurance.
No-fault insurance will cover all of your medical bills up to $50,000 or if you are terminated from coverage, as per an Independent Medical Exam. Therefore, sometimes, you may need medical treatment but no longer have no-fault benefits to pay for that treatment. In this situation, you will be left with a few options. First, you can submit your medical bills to your health insurance carrier. The carrier will likely want to see a denial from no-fault before agreeing to pay for medical treatment.
If you are a Medicaid recipient you can submit your medical bills to that entity once no-fault is denied. There are two issues I see arise with this situation. First, not all doctors accept Medicaid. Therefore, you might need to switch healthcare providers. While this is inconvenient, it is better than the alternative of receiving no treatment. The second issue that arises is that unlike no-fault, Medicaid must be reimbursed for medical payments should you receive a settlement.
Medicare works similar to Medicaid in that it will cover medical expenses once your no-fault benefits are denied. Also, like Medicaid, if a settlement is reached, Medicare will be entitled to reimbursement for its expenditures.
Another option to get medical bills paid is to approach the healthcare provider about accepting a lien on your personal injury settlement. I often can get a healthcare provider to continue treating a client while their case is proceeding and await settlement before receiving payment. Obviously, this will not be an option if you are not pursuing a bodily injury settlement. It is also likely a last resort as it is always better to get an insurance company to pay for the treatment up front because they are only entitled to repayment if you receive a settlement. On the other hand, a doctor’s lien will usually stipulate that you are responsible for the bill should there be no settlement.
The last option for getting medical bills paid is through a personal injury lawsuit. If another person causes your injuries, they are responsible for any economic damages associated with that injury, including medical bills not covered by no-fault. There is a caveat to this rule. It must be proven that you have suffered a “serious injury” from the motor vehicle accident before the responsible party is required to pay for your economic losses. “Serious injury” is defined by a law.
Finally, should you run into any problems with receiving medical payments, it is always a good idea to speak with an attorney. They can often solve the problem and get you reimbursed for your losses.
Property damage generally refers to your vehicle and any property in your vehicle that is either damaged or completely ruined in the automobile accident. You can make a claim for your property damage one of two ways. You can file a claim with your insurance carrier if you have purchased collision coverage. Another option is you can pursue reimbursement through the other party’s insurance carrier. There are benefits and drawbacks to both options, as I will discuss below.
Filing a claim through your automobile collision coverage has several advantages. First, your own insurance company has a vested interest in making you happy since you are a paying customer. They will be more responsive to your needs and provide better customer service. Since you are entitled to collision coverage as per your insurance contract, fault is not an issue. Therefore, there is no need to complete an investigation of the accident prior to paying for your property damage claim thus speeding up the process.
The only drawback to filing a claim through your insurance carrier is there is usually a deductible. A deductible is an agreed upon amount of money you must contribute to the repairs or replacement of your property damage. Most deductibles range between $500 and $1,000 dollars. The good news is that, after completing your insurance company’s accident investigation, you may be entitled to full or partial reimbursement from the other person’s insurance carrier. Further, your carrier will fight to get the money back for you. This is accomplished in an inter-insurance company arbitration proceeding against the offending vehicle’s insurance company.
Filing a collision claim is a better option than pursuing a claim through the other vehicle’s carrier. The only time I recommend a client with collision coverage to pursue a claim through the other carrier’s policy is when they do not have the financial resources to pay their deductible.
When pursuing a claim through your own collision coverage is not an option, you can file a claim with the other vehicle’s insurance carrier. However, fault will be a key issue in the claim. This is because the carrier will only be responsible for their client’s proportionate share of fault in the accident. Therefore, prior to issuing any payments, the insurance carrier will complete a thorough investigation. This will include obtaining a police accident report, witness statements, and an inspection of all damaged property.
The insurance company will likely be biased. If there are multiple versions of the accident, they will likely accept the version favorable to their client. Further, they will be less responsive to your needs as they have no financial relationship with you. Also, the carrier does not have to make a settlement offer to you. They will only do so if they feel it is in their best interests to settle because they have no chance of winning if the case goes to court.
However, if the carrier refuses payment or offers a payment that is less than you feel is acceptable, you can pursue recovery in court. Unfortunately, this is an arduous process and will likely require the services of an attorney.
Should you agree on a settlement with the carrier, you will likely be asked to sign a release. Be careful when signing a release with an insurance company. Read it carefully and make sure you understand the contents. Never sign a document you do not fully understand. Further, make sure that the release pertains to your property damage only. This is extremely important because signing a general release will bar you from pursuing a bodily injury claim. Even if you do not believe that you are injured, never sign a general release in a property damage settlement. You never know if you are suffering from latent injuries that may reveal themselves later on.
New York is one of twelve states that have enacted no-fault laws. Each state’s no-fault laws vary. So, if you are not familiar with New York’s no-fault laws, this blog may be helpful. The purpose of New York’s no-fault laws is to ensure that car accident victims receive compensation for accident-related medical bills, lost wages and other incidentals regardless of fault. The insurance carrier of the vehicle you are occupying will pay those costs regardless of fault. If you are a pedestrian or bicyclist, those expenses will be borne by the insurance carrier of the vehicle that comes into contact with you.
To qualify for no-fault benefits, you must be a motor vehicle operator, passenger, pedestrian or bicyclist. Motorcyclists are not eligible for no-fault coverage. Also, to receive benefits, all qualified parties must complete a no-fault application with the proper insurance carrier within 30 days of the accident. Failure to do so may result in the denial of your no-fault benefits. I always advise people to complete the application and mail it certified return receipt requested. This ensures that the carrier cannot dispute it was filed promptly.
The insurance carrier will mail the application to you once the accident is reported to them. In some instances, you may not immediately know which insurance carrier is responsible for your no-fault benefits. For example, a pedestrian will likely not know the carrier of the vehicle that struck them. In such instances, insurance information can be obtained from the police accident report.
Also, if the insurance carrier responsible for your no-fault claim is not your own company and you have no-fault insurance on one of your household vehicles, I would advise completing an application with your own carrier within the 30-day deadline. This will give you an added layer of insurance should the vehicle that is responsible turn out to be uninsured.
No fault insurance will generally cover all of your accident-related expenses.
However, certain limits will apply. First, New York requires at least $50,000 dollars’ worth of no-fault coverage. A person may purchase additional no-fault coverage and would be wise to do so considering the cost of medical treatments. Out of that pool of money, you will receive payments for medical expenses, lost wages, household help, and transportation to and from medical appointments.
Generally, all healthcare providers accept no-fault insurance. Further, there are no deductibles or copayments. Also, you don’t need referrals. But, since a few providers do not accept no-fault insurance, as a precaution you should always confirm before receiving treatment. I advise providing the doctor’s office with your no-fault claim number at the time that you schedule your appointment. This way there is no confusion with the healthcare provider about how they are being compensated. There is nothing worse than showing up at a doctor’s office only to be turned away because of an insurance issue.
If you were taken to a hospital on the date of your accident, it is likely that you did not have a no-fault claim started before receiving treatment. I recommend that you immediately contact the hospital once you file your claim so they can bill the proper insurance carrier. If you fail to do this, the hospital will bill you directly. Also, if any bill is not submitted to the no-fault carrier within a reasonable time, it can be denied. That could mean you could be left on the hook for that bill.
Should your no-fault benefits be exhausted before you complete treatment, you must use your own personal healthcare insurance to pay for medical treatments. Unfortunately, this will mean you will incur customary deductibles and may need to obtain referrals as per your private health insurance agreement.
No-fault insurance will also cover up to 80% of your accident-related lost wages up to two thousand dollars a month. To receive this benefit, you must provide a doctor’s note from a treating physician attesting to the fact that you cannot work. Your employer must also provide a wage verification form, as well. The carrier has up to 30 days to provide wage payments once the documentation is submitted. You must submit the wage verification form to your employer. Be sure to follow up with them to make sure it is returned to your insurance carrier. You can obtain the form from your insurance carrier. I always recommend that you continue to follow up with the adjuster to make sure that they have all the documents necessary to start your payments. The adjuster will also request updated doctor notes periodically.
For some people, the no-fault maximum lost wage benefit will not adequately reimburse them for their lost wages. For example, if you earn more than two thousand dollars a month, you will be receiving less than your full paycheck. It is best to keep track of your unreimbursed lost wages. If you file a claim against the at-fault driver, it’s possible to get reimbursed for those unreimbursed lost wages.
Finally, no-fault insurance will cover up to twenty-five dollars per day of accident-related expenses for such things as travel and household help. Again, you must submit proof to your no-fault carrier of such expenses prior to reimbursement.
An Independent Medical Exam (IME) is a physical examination with a doctor
hired by a no-fault insurance provider. The exam determines whether you still need medical treatment. The term “Independent” is used to describe the exam, but as you can imagine there is an incentive for the medical doctor to find you no longer need treatment since it is the insurance carrier hiring the doctor.
The independent medical doctor only has the power to terminate or reduce treatment in that doctor’s specific area of expertise. For example, an orthopedist cannot terminate or reduce your treatment with your treating neurologist. Further, the insurance carrier must provide you a claim denial accompanied by the doctor’s written report before your benefits for any particular medical discipline can be terminated.
Further, terminating your medical benefits may also result in termination of your lost wage payments. For example, if your orthopedic doctor has provided the written proof of your inability to work and an orthopedic IME doctor finds you no longer need treatment, your lost wages will stop.
If you disagree with the independent doctor’s decision following your exam, there is an appeals process. You can request an arbitration with an independent arbitrator. However, the process is complicated, time-consuming and takes several months to schedule. This may be impractical for someone undergoing active treatment. I generally recommend that once no-fault benefits are terminated by the carrier that my clients use their private health insurance to pay for medical treatments. The private carrier may want to see the no-fault denial prior to paying for medical bills.
Generally speaking, no-fault insurance can be quite complicated. Most attorneys that handle personal injury cases will also handle all of your no-fault issues. However, be aware that there may be an additional charge for such services.
Steven Palermo is the managing partner for Palermo Law, Long Island’s Personal Injury Law Firm. He has been helping people receive compensation for their injuries for over 21 years. He focuses on cases involving car accidents, truck accidents, construction accidents and slip and fall injuries.
His book The Ultimate Guide to Handling New York Car Accident Claims details the ins and outs of a car accident claim in a simple, easy-to-read manner.
By New York State law, every insurance carrier must offer Supplemental Uninsured Motorist (SUM) Coverage. This type of coverage is extremely important if you’re ever seriously injured by a driver who is underinsured, uninsured, driving a stolen vehicle or commits a hit and run against you. If the at-fault driver is uninsured or underinsured and has little-to-no assets, your compensation comes from your Supplemental Uninsured Motorist coverage. If the at-fault driver is insured, their Bodily Injury Liability (BIL) coverage will compensate for your medical costs, lost wages, and pain and suffering until that coverage is exhausted. Your SUM coverage will then make up the difference of the compensation you’re entitled to until it is exhausted. Many drivers choose the minimum amount for both BIL and SUM coverage, and if this is the case, you could be at a loss to recuperate your damages. Especially if the at-fault party has little-to-no assets. Choosing the minimum amount for these two types of coverage can lead to a serious financial crisis.
The minimum coverage New York State insurance carriers offer is $25,000 for one person, $50,000 per occurrence, and $10,000 for property damage. But what could this amount really do if you are seriously injured? How would this scarce amount of money help fully compensate for your damages? And what if other family members were seriously injured in this type of accident? In many cases, it simply won’t help at all. $25,000 is a grossly inadequate amount to compensate for damages in a serious personal injury case.
In a vast majority of the car accident cases we’ve seen, the at-fault driver had the minimum Bodily Injury Liability coverage or was not covered at all with little-to-no assets. It’s not always the case, but many times it is. This is why it’s imperative to consider a higher amount for your Supplemental Uninsured Motorist coverage. If you choose the minimum, and the at-fault party is uninsured and with little-to-no assets, you won’t receive compensation from their insurance company, nor will you be able to get compensation from them through a lawsuit. If the at-fault party has the minimum amount of BIL coverage, you’re entitled to that compensation, but it will do little to recuperate for your damages if you’re seriously injured.
As you may know, insurance brokers get commissions based off of their sales. Some won’t tell you about how important it is to have a high SUM coverage to protect you and your family residents. Why? Because they know you may think having a higher-than-minimum SUM coverage will create a drastically higher monthly premium. The last thing insurance brokers want to do is scare you away from an insurance package, and the first thing they want to do is make the sale. So, some don’t push you to have a higher SUM coverage out of fear of losing that sale. But if you actually calculate the annual add-on, it’s not that bad. And it’s worth it.
We urge you to get a simple quote online to see how much money will be added on to your annual premium if you raise your SUM coverage. Whatever amount of money that is, compare it to the amount of money you would lose if you were hypothetically hit by an underinsured or uninsured driver, whether you were in a car or pedestrian accident, and sustained serious injury. You wouldn’t be able to work, you’d experienced hefty medical bills, both your car and your life could be totaled – the list could go on and on. You’ll probably come to the realization that it is most definitely worth it to get the highest SUM coverage you can afford. If you have a high SUM coverage, you and your family residents are protected in case you’re injured by an underinsured or uninsured driver. We simply cannot overstate how very important a high SUM coverage is.