No-Fault Insurance Claims And Why Companies Must Pay Them
No-fault insurance is part of car insurance that covers medical bills if someone is involved in an accident. It is very useful to the policyholder, but the insurance company will often withhold payment for services if they deem them unnecessary.
As a no-fault insurance claim attorney, I make sure insurance companies do pay these rightful benefits. I often work with medical providers, though I also sometimes work with the individual policyholder to ensure they receive the payment they deserve for medical services rendered.
Wages Owed Under No-Fault
A person who is injured in a motor vehicle accident is eligible for reimbursement of lost wages for three years after the accident. At a minimum, your no-fault insurance must cover up to $2,000.00 per month (you can always pay for extra coverage in your personal policy).
We have worked on hundreds of lost wage cases covering a variety of non-payment issues ranging from: Independent Medical Examination denials; Peer Review denials; coverage denials; small business ownership; contract workers, etc.
Please call our office today for a one-on-one consultation regarding any questions as to your wages potentially owed.
Continuing Care after No-fault Denial
More and more, we are seeing carriers issue denials for treatment earlier and earlier on the basis of Independent Medical Examinations (IMEs); Peer Reviews; and Biomechanical Reports. The carriers use these reports to cut off your treatment. It is important for you, to the best of your personal ability, to continue to receive care to establish continuity of care, as large gaps in treatment are extremely difficult to explain/overcome.
An IME is a misnomer. The medical examiners are not truly independent. The physical exams are often brief, do not properly review medical records, and do not properly diagnose patients’ conditions.
A Peer review is only a review of your medical treatment records by an “independent” medical provider, who purports to diagnose/recommend treatment based only on a review of records.
A Biomechanical Report is perhaps the most insidious. This “expert” reviews accident photos, medical reports, and accident reports, then attempts to make an opinion regarding the force of the accident and how it could (or more often) could not have caused the injuries a person sustained.
No matter what mechanism your insurance carrier uses to end your treatment, again, we recommend you listen to your personal treating physicians and, to the best of your ability, do what they recommend. We work with a variety of offices who will continue to treat patients no matter what the insurance carrier’s “experts” determine. We can also help your doctor understand the process and help them fight back against the insurance company.
Out-Of-Pocket Expenses (Other Reasonable & Necessary Expenses)
A person who is injured in a motor vehicle accident is eligible for reimbursement of reasonable and necessary expenses (other than medical expenses and lost wages) up to $25 per day for one year after the accident. These types of expenses can include transportation costs to and from your doctors; babysitting costs while you are disabled; and replacement of household chores, etc.
How To Get Started
The process of getting insurance companies to pay out no-fault insurance claims may sound complicated, but is very simple. This is how it works:
- All related documents will be reviewed, with the aim being to file within seven days after receiving all necessary documentation. Related documents include a signed assignment of benefits, any bills that were denied and the denial communication and all medical records.
- The insurance company has an opportunity to respond and bears the burden of establishing that the medical treatment was not medically necessary.
- Even if the insurance company initially submits the proper evidence (which is expected), we have a further opportunity to rebut their submission by providing additional evidence.
Unlike some other firms, I do not ask for any fee up-front. Once you provide your documents, I will get started and work to resolve the matter as efficiently as possible. I help all types of medical professionals: doctors, chiropractors, surgeons, neurosurgeons, massage therapists, pain management specialists or any other type of specialist.
for a Checklist of Items Sent and Intake Form
Contact Me Today
To reach my office, call Pasquale V. Bochiechio, P.C. at 716-267-6252 or send me an online message. My office is located in Cheektowaga, and I serve clients throughout the Buffalo and Niagara metro areas.