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No-fault Termination of Benefits
NO-FAULT BENEFITS CAN BE TERMINATED AND HERE'S HOW IT CAN HAPPEN:
Q. I WASN'T TAKING GOOD CARE OF MYSELF AND JUST DIDN'T GET ANY TREATMENT
FOR MY INJURIES FOR OVER A YEAR. NOW NO-FAULT WANTS TO CUT OFF MY BENEFITS.
CAN THEY DO THAT?
A. Termination is allowed when the insurer can show that the policy contains
a one-year lapse provision and there was a one-year lapse in the treatment
or disability. The no-fault insurer must notify you in writing sixty (60)
days before the one-year lapse. It is important to have a yearly checkup
to avoid termination. If your disability has lasted over one year, you
can argue that you should not be cut off.
Q. MY INSURER HAS DEMANDED THAT I ATTEND AN "I.M.E." WHAT
IS IT AND WHAT IS EXPECTED OF ME?
A. After providing no-fault benefits for a period of time, the insurer
can demand that the injured person attend an "independent medical examination." This
medical examination is always paid for by the no-fault insurer with the
goal of cutting off the injured person's no-fault benefits. By law you
are required to attend. Your attorney will answer your questions about
this examination.
Q. WHAT HAPPENS IF I GET CUT OFF OF MY NO-FAULT MEDICAL BENEFITS?
A. If your benefits are terminated, you have a right to file a claim for
mandatory arbitration with the American Arbitration Association. At the
time the arbitration is filed, the unpaid benefits must total less than
$10,000. Your attorney will assist you with arbitration. If your No-fault
benefits are cut off, you must use your private health insurance for the
payment of your medical bills related to the crash.
Q. WHAT REASONS MIGHT THE INSURER USE TO DENY MY NO-FAULT
BENEFITS? ("RED
FLAGS")
A. The following are considerations which may be used to cut off your
No-fault benefits:
1. You have experienced similar complaints and injuries prior to the accident.
2. Your early symptoms are inconsistent with later treatment.
3. The medical records document that your symptoms have improved.
4. You fail to follow medical recommendations for follow-up visits, self-care,
exercise, etc.
5. You have long periods where you have not treated with a medical doctor
or physical therapist or chiropractor.
6. You have a lack of objective findings. In other words, you have no
way to prove the extent of your injuries other than your own testimony.
7. You go to a doctor for health care unrelated to your accident and the
medical records from that visit document that the "affected areas" (those
injuries caused by the accident) are normal.
8. You failed to report your injuries or received no treatment for several
weeks or months after the accident.
9. After 9 months to a year, you have experienced no improvement with
medical care. If this is the case, the insurer will likely terminate the
benefits because they will argue that the treatments are not beneficial.
10. You have had unusual treatment techniques, or unusually expensive
or extensive treatment techniques.
11. Your medical professional over-treats you, such as recommending treatments
3-5 times per week.
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