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No-Fault Insurance and IMEs

by: Michael Rose

What is No-Fault Insurance?

New York requires every insured vehicle to carry a no-fault policy with a minimum of $50,000 to cover medical expenses, lost wages, and other benefits regardless of who is at fault for an accident. This extends to the vehicle’s driver and passengers, as well as bicyclists and pedestrians struck by the vehicle. Motorcyclists are excluded from no-fault benefits.

Notify the Insurance Company

The first thing you need to do if you are injured in an auto accident is to notify the relevant insurance provider, which typically is the driver’s insurance provider. If you are the driver of the vehicle, make sure to inform the insurance company of any injured passengers. Injured pedestrians and bicyclists will need to call the striking vehicle’s insurance company to receive no-fault benefits. If you are a passenger, pedestrian, or bicyclist and you or anyone in your home owns an insured vehicle, you should also notify that insurance company since you might be eligible for further coverage.

30-Day Deadline

You will receive a no-fault application from the insurance company (or companies), which you will have a strict 30 day deadline to respond by. Insurance companies can deny your claim if they do not believe your excuse for failing to submit the application within the 30 days is reasonable.

Independent Medical Exams (IME)

Insurance companies require those receiving no-fault benefits to submit to an Independent Medical Examination (IME). The insurance company hires a doctor to perform the exam to determine the severity of the injury, whether further medical treatment is required, whether you are able to return to work, etc. The examination is short (about 3-10 minutes), and the doctor will ask you to move your body in order to measure your range of motion. If the doctor determines that your range of motion is within a normal range he could conclude that you no longer need medical treatment.

While this may sound fair and reasonable, it can be anything but. These doctors are paid by the insurance companies, and they are paid well. In order to keep receiving these lucrative referrals from insurance companies, these doctors are incentivized to make the insurance companies happy. Insurance companies are happy when they minimize or deny a claim, and IMEs are their means to do so; if their doctor decides you no longer require medical treatment, insurance companies are able to deny coverage of medical expenses. It is very important to attend the IME. If you fail to appear for the IME, the insurance company has the right to terminate your benefits and you may become financially responsible for your outstanding medical bills.

How to Act During an IME

You must remember in an IME the doctor is hired by the insurance company. They can be looking for an opportunity to downplay your injuries so the insurance company can deny your claim and stop paying for medical benefits. There is no physician-patient relationship, which means anything you say and do can be held against you. If you are able, you should bring a family member or friend with you and have them take notes on what is discussed and keep track of the time to help avoid and resolve any discrepancies. To best protect yourself and your medical benefits, you should talk with a Personal Injury attorney before attending an IME.

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