If you are involved in a motor vehicle accident in New York State and sustain injuries, no-fault insurance will likely be your primary insurance coverage for your medical bills and lost wages. The no-fault carrier that is responsible for your medical bill will be the insurance carrier of the vehicle that you were riding in at the time of your accident, regardless of who was at fault for the accident. If you were a pedestrian or bicyclist your no-fault carrier will be the insurance carrier of the vehicle that struck you.
When you seek treatment for your injuries following a car accident you will have the option of choosing whatever doctors that you feel are best suited to treat your injuries. There is no need for referrals or pre-approvals. You are free to see whomever you want as much as you need to. As you can imagine this can get expensive for the insurance carriers. Therefore, the law allows insurance carriers to request that you attend Independent Medical Examinations (IME) to determine if the treatment that you are undergoing is medically necessary. If the doctor that examines you determines that you have successfully healed from your injuries that doctor will terminate your no-fault benefits.
Insurance companies are required to give you reasonable notice of your exam in writing prior to your IME. Also, your exam must be scheduled at a convenient location. This usually means the exam will be scheduled in the county where you live. Further, you are allowed to reschedule your exam one time. However, should you reschedule your exam and then miss your second exam, the carrier will automatically terminate your benefits. Finally, you are entitled to a full copy of your IME report from the insurance carrier following the exam.
It is important to understand that the term Independent Medical Exam is somewhat of a misnomer. The doctor that examines you may not be an employee of the insurance carrier requesting the IME, but he is certainly paid by that carrier. Further, IME doctors often examine hundreds of patients a year for their insurance carrier. So, it is safe to say that the doctor will usually err on the side of the insurance carrier and often terminates a patient’s treatment prior to them reaching a full recovery.
So, what should you do if you are requested to attend an IME? First, you should make sure that you attend the exam or if necessary, reschedule it. But, beware if you miss your second exam your benefits will be terminated retroactively. This means the carrier will not pay for any treatment past present or future. Therefore, your doctor will likely try and bill you for the unpaid treatments. At your exam you should not discuss the facts of your accident. You should only answer questions related to your injuries and medical treatment. It’s also a good idea to take some notes after the exam. Keep track of the length of time the exam took as well as the tests that were done and any conversations that you had with the doctor.
Finally, if your no fault benefits are denied there is no need to panic. You still have options to continue your treatment if necessary. First, you can always arbitrate the decision. Second, once your benefits are terminated you can use your private health insurance. All you will need to do is provide your carrier with a copy of your denial. Finally, many doctors will be willing to treat you risk free. They will then try and get the medical bills paid by having you sign an assignment of benefits giving them permission to arbitrate the bills with the insurance carrier directly and should they loose you will not be responsible for the unpaid bills.
No-fault issues can get complicated. It’s always a good idea to speak to a qualified personal injury attorney if you have any questions or concerns.
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.