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No-Fault Law in New York and What Documents Your Claim Should Have

Written by: Stacy Mandel Levine

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Posted over 2 years ago. Applies to New York, 1 helpful vote, 0 comments

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Claim Information

You should know your patients name, address, date of birth, accident date, and insurance carrier information (claim number and policy information). Try to get a copy of the insurance card, police report, and the name, address and contact info for any PI attorney if they are using one. A copy of the NF-2 application for benefits form will also be helpful.

Claim Papers

Any medical treatment or services should be memorzlized in a medical report. If the services are PT, have the PT SOAP notes. Chiropractic? Treatment notes. Surgery? Surgical report. Consultation? Detailed consultation report. The more details you can give to the insurance carrier up front, the better for the processing of the claim.

No-Fault Forms

The statutory NF-3 Verification of Treatment Form, The AOB Assignment of Benefits, and your reports should be submitted together to the insurance carrier.

Watch the Clock

No-Fault medical providers in NYS have 45-days from the date of service to submit the claims. So, do not wait and submit your claims within 45 days. If you are submitting yourself, make sure to have a Proof of Mailing for any claim, so you can later evidence the date. If your attorney is submitting for you, they should have this proof of mailing.

Then, Watch the Clock some more

No-Fault insurance carriers have 30 days to pay or deny your claim, or, to seek verification of the claim. If verification is sought, you should respond to this as soon as possible. Again, if you are submitting yourself, make sure to have a Proof of Mailing for any claim, so you can later evidence the date. If your attorney is submitting for you, they should have this proof of mailing.

Payment or Denials of Claim

Payments or denials from the carrier can be challenged if not fully and properly paid, or if denied late. An attorney can help you determine if you may pursue benefits for the late processing of the claim, or for a denial for lack of medical necessity, or another denial reason.