The insurance company is not paying any more claims.
Personal injury cases only; I'm good at it; you be the Judge! All information provided is for informational and educational purposes only. No attorney client relationship has been formed or should be inferred. Please speak with a local and qualified attorney. I truly wish you and those close to you all the best. Jeff
The no-fault insurance carrier is denying all or part of your claim. It can be for a variety of reasons but should be listed on the form.
I am a former federal and State prosecutor and have been handling criminal defense and personal injury cases for over 18 years. The above answer, and any follow up comments or emails, is for informational purposes only and not meant as legal advice.
No fault is denying to pay either medical or lost wages for whatever reason is listed on the denial form.
Under New York's "No-Fault" law, your car insurance company pays for your prescribed medical treatment and testing. Your car insurance company does not get to deny authorization for treatment in advance like your health insurance can by stating the prescribed treatment is not medically necessary. However, your car insurance can issue a denial of claim form if it subsequently has you examined by a physician in the field of medicine you are getting treatment from. If that insurance medical exam results in the doctor writing a report that says you don't need further treatment, your insurance company can cut off future treatment by sending you a denial of claim form with the examining doctor's report. Your insurance company may also decline to pay all or part of your wage loss benefits by issuing a denial of claim form and must state the reason for the denial. If you receive a denial of claim form from your car insurance company, you can submit the denial to arbitration. In the meantime, you can submit your medical bills that are being denied to your own health insurance company.
An insurance company will issue a denial of claim form when it has decided to deny payment. Insurance companies will issue a standard "Denial of Claim" form that sets forth whether the denial is full or partial, the amount denied, and the reason for the denial. Some common reasons for denial are failing to timely apply for benefits; failing to timely submit a bill; a bill amount that exceeds the no-fault rate; or an IME report that says the patient needs no further treatment. The reason for denial is usually set forth at the bottom of the first page or on a separate page.
You can challenge the denial by arbitration or commencing suit in the court system. Depending on the amount, it may be worth considering small claims court.
This information does not create an attorney-client relationship.
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