Category Archives: No-Fault

Articles about No-Fault for New York accidents including information about filing a No-Fault claim, No-Fault denials, getting No-Fault to pay for plastic surgery and dental treatment, and more information about No-Fault.

How Do I Dispute a No Fault Denial?

Q. Can my lawyer file an arbitration demand or a lawsuit against the insurance company to dispute or fight a No Fault denial?

A, Yes and no. When No-Fault denies you further medical treatment or lost wages, you or your lawyer can file a No-Fault arbitration or lawsuit. But if you have an open personal injury case, your lawyer cannot file a No-Fault arbitration or lawsuit on your behalf because doing so could be malpractice.

Why? Filing an arbitration demand or a lawsuit to dispute a No-Fault denial, can ruin your personal injury case for pain and suffering. If an arbitrator or judge rules that your injury was not caused by your car accident, you will not be able to include the injury in your personal injury case and if it’s the only injury, you just lost your personal injury case.

What should I do to dispute a No-Fault denial? You should wait until your personal injury case has been settled.

medical no-fault claim denied stamp

Why Did I Get a No Fault Denial?

Usually, within 4-8 months after you were injured in a car accident, bicycle accident, or pedestrian accident your insurance company will send you a notice to appear at an IME (Independent Medical Exam) that will usually take 5-15 minutes.

We call the IME an NFE or No-Fault Insurance Exam because there is nothing independent about the exam and it isn’t a medical exam.

The No Fault exam is conducted by a doctor who works for a company that is hired by your No-Fault insurance company. IME doctors have told me that if they don’t deny the majority of claimants, they will not be given more exams to do. Considering that one of these doctors can make $400 for an exam that lasts for 5-15 minutes, that’s a lot of financial pressure.

Now you can guess why you were denied further medical treatment and other No-Fault benefits!

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How Can Disputing or Contesting a No-Fault Denial Can Ruin a Personal Injury Case?

Disputing or fighting a No-Fault denial by filing an arbitration demand or a lawsuit can ruin your personal injury case if the arbitrator or judge rules that your injury was not caused by your car accident.

The ruling or decision is binding on your personal injury case and you will no longer be able to claim your injury was caused by your car accident.

What Law Makes the Decision Binding on Your Personal Injury Case?

The legal doctrine of collateral estoppel prevents you or your lawyer from re-litigating the issue of whether your injury was caused by your car accident.

If your personal injury attorney files a No-Fault arbitration demand or a lawsuit against your No-Fault insurance company before your personal injury case is finished, your personal injury lawyer could be committing legal malpractice. Consequently, your personal injury lawyer will not agree to file a No-Fault arbitration demand or lawsuit.

If you are already represented by a personal injury lawyer for a car accident and your lawyer tells you there is nothing you can do, now you know why.

Is There Another Way To Dispute a No-Fault Denial Without Ruining My Personal Injury Case?

Yes. We have been successful in reversing No-Fault denials when our clients need surgery and the No-Fault denial was issued before getting surgery.

It is time-consuming but we do it without filing an arbitration demand or a lawsuit against the No-Fault insurance company, so there is no risk to the case.

How Do I Dispute a No-Fault Denial?

Do not fight a No-Fault denial if you have a personal injury lawyer representing you for an injury from a car accident. You must speak with your personal injury lawyer before you do anything.

If you still want to fight a No-Fault denial you can

If you submit a No-Fault claim to an insurance company and the insurance company does not respond to the submission of your claim within 30 days of receiving it, or if the insurance company sent you a denial of claim form (NF-10 that looks like this), your have the following options:

  • File a written complaint with the New York Department of Financial Services
  • File a lawsuit against the insurance company
  • File a No-Fault arbitration with the American Arbitration Association (AAA)

How to file a No-Fault arbitration in New York with the American Arbitration Association

Rules for Arbitration of No-Fault Disputes in the State of New York

How Do We Dispute a No-Fault Denial?

We get the evidence we will need and then arrange to get you a new No-Fault exam. We go with you to your No-Fault exam and give the evidence to the No-Fault exam doctor. It’s more complicated than that but we consider our method as a proprietary trade secret.

If you need surgery and were denied medical treatment by a No-Fault denial, and want us to represent you, please call us for a free consultation. See How To Change Your Personal Injury Lawyer In New York.

Related Articles

Everything you want to know about No-Fault

Why Isn’t No-Fault Paying My Medical Bill

Can I reopen my no-fault file?

See more answers to FAQs

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Attorney Franckel is a well-known personal injury lawyer, Founding Partner of 1-800-HURT-911® New York, and a former Member Board of Directors of the New York State Trial Lawyers Association. He has an Avvo Top 10  Rating, Avvo Client’s Choice Award with all 5-star reviews, Avvo Top Contributor Award, Multi-Million Dollar Trial Lawyers Award, and other awards. See Mr. Franckel’s bio for areas of expertise.

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Philip L. Franckel, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York; He has a 10 Avvo rating; Avvo Client’s Choice with all 5-star reviews; Avvo Top Contributor; and a former Member of the Board of Directors of the New York State Trial Lawyers Association.

1-800-HURT-911® Founding Partner and Personal Injury Lawyer Rob Plevy, Esq.

Founding Partner Rob Plevy, Esq.

Robert Plevy, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York. Rob began his legal career in 1993 as an Assistant Corporation Counsel defending The City of New York against personal injury lawsuits.

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Can I Reopen My No-Fault File?

Q. Can I Reopen My No-Fault File After It Was Closed?

A. Yes. Closing a No-Fault file is a common and unscrupulous trick insurance companies use to prevent you from getting medical treatment. If the insurance company or your doctor told you your No-Fault file was closed, it is probably not closed.

Note: Closing a No-Fault file is different than a denial of further medical or other benefits. Keep reading to find out the difference and what it means to you.

Keep reading to see why and what you need to do.

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How Insurance Companies Close Your No-Fault File

Insurance companies “close” a no-fault file for inactivity. A no-fault file becomes inactive if the insurance company doesn’t receive a bill for medical treatment within a few months. The insurance company then simply “closes” your file.

It’s like archiving a file on the computer and can be easily reactivated or reopened at any time.

What Happens When Your No-Fault Insurance Company Closes Your No-Fault File?

You will usually find out your no-fault file was “closed” when you go to a doctor and your doctor calls your no-fault insurance company to make sure they will get paid.

Your doctor’s office will call and ask the claims representative “is Jane Doe’s no-fault file still open?”

The claims representative will reply, “No, the file is closed” and your doctor will tell you that you need another source of payment to receive medical treatment.

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Why Do Insurance Companies Close Your No-Fault File?

That’s simple. They do it to save money so they don’t have to pay for your medical treatment, thereby defrauding their insureds.

Their stated purpose is so they don’t clog up claim representatives’ computer screens with hundreds of open files when claimants are no longer being treated.

How Can I Reopen My No-Fault File?

That’s also simple. Just tell your doctor to send another medical bill to be paid by No-Fault. When your no-fault insurance company receives the bill for payment, they will simply reopen your no-fault file.

What Are the Reasons My No-Fault File Can Be Closed?

Your No-Fault file can be closed if:

  • The No-Fault insurance company paid out all of the money that was available in the policy.
  • You failed to appear at an examination under oath when requested.
  • You failed to not appear for a medical exam by a doctor chosen by the No-Fault insurance company (in New York, you are entitled to reschedule your exam appointment once).
  • Other violations of No-Fault regulations.
  • Your No-Fault file can be closed (technically never opened) if you did not file a No-Fault application within the 30-day time limit to file.

New York No-Fault claims cannot be settled like a personal injury claim.

You can be denied further medical benefits for a particular medical specialty if you have been examined by a No-Fault doctor in this same medical specialty. For instance, an orthopedic surgeon working for No-Fault cannot stop you from seeing a neurologist.

If you are examined by an orthopedic surgeon working for the No-Fault insurance company and the No-Fault orthopedic surgeon issues a report denying you further orthopedic benefits, you won’t be able to get No-Fault to pay for your orthopedic treatment. Your orthopedic benefits have been denied but your No-Fault file has not been closed.

What Is the Difference Between Closing a No-Fault File and a Denial of Further Benefits?

Being denied further medical benefits is different than closing your file because you have the right to file a lawsuit or arbitration claiming that you were wrongfully denied medical benefits. If you win, you will be entitled to have no-fault pay your doctor again.

If your No-Fault file is truly closed, like when your No-Fault coverage is exhausted because all the money was paid out for your benefits, there is nothing you can do.

Can I Fight a No-Fault Denial of Benefits?

Probably not and that’s a good thing for you.

You probably signed an assignment of No-Fault benefits to your doctor when you first went to see a doctor after your car accident. Doctors who accept No-Fault in New York will want you to sign an assignment of No-Fault benefits or make you pay for treatment upfront.

An assignment of No-Fault benefits means that you gave your right to be reimbursed for medical treatment to your doctor. This allows your doctor to be paid by No-Fault instead of sending you a bill.

Why is an assignment of No-Fault benefits good for you? Because your doctor is not allowed to bill you for the difference between what No-Fault pays and what your doctor charges and you are not responsible to pay your doctor.

Can I Fight a No-Fault Denial of Further or Future Benefits?

You should never file a lawsuit or arbitration to contest a No-Fault denial until after your personal injury case has been settled because if a decision is made that your injury was not caused by your car accident it is binding on your personal injury case.

For that reason, if a personal injury lawyer files a lawsuit or arbitration to contest a no-fault denial before your personal injury case is settled, it could be legal malpractice.

However, we have been successful in getting the No-Fault insurance company to reverse a denial when our client needed surgery. This is a very time-consuming process and we can only do this for people who we represent for a car accident in New York. If you already have a car accident lawyer in New York and are willing to change your lawyer to us, we may be able to help you. See how to change your lawyer in New York.

See more reasons why No-Fault may be denying your medical bills.

See more FAQs

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Attorney Franckel is a well-known personal injury lawyer, Founding Partner of 1-800-HURT-911® New York, and a former Member Board of Directors of the New York State Trial Lawyers Association. He has an Avvo Top 10  Rating, Avvo Client’s Choice Award with all 5-star reviews, Avvo Top Contributor Award, Multi-Million Dollar Trial Lawyers Award, and other awards. See Mr. Franckel’s bio for areas of expertise.

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—Lia Fisse

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What will happen when I call 1-800-HURT-911 or chat?

  1. Our call center operators and chat operators are available 24/7.
  2. Just give your contact info to our operator and Founding Partner Rob Plevy, Esq. will call you within 5-10 minutes for your free, no-obligation consultation during the hours of 8 am – 10 pm. After hours, Rob will call you in the morning or at the time you want.
  3. Then just text or call us any time you want during your case!

Because any delay could cause you to lose viable rights and benefits, please call HURT-911® Founding Partner Rob Plevy, Esq. right now for a free consultation to find out your rights days/nights/weekends.
1-800-HURT-911
1-800-487-8911

You can speak, text, or email with us whenever you want throughout your case and afterward, days/nights/weekends, and experience our famous personal service. You’ll even get our personal phone numbers so you can call or text anytime!

Watch Founding Partner Phil Franckel, Esq. talk about New York Serious Injury Attorneys.com, difficult cases, and the 1-800-HURT-911® Dream Team™


Philip L. Franckel, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York; He has a 10 Avvo rating; Avvo Client’s Choice with all 5-star reviews; Avvo Top Contributor; and a former Member of the Board of Directors of the New York State Trial Lawyers Association.

1-800-HURT-911® Founding Partner and Personal Injury Lawyer Rob Plevy, Esq.

Founding Partner Rob Plevy, Esq.

Robert Plevy, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York. Rob began his legal career in 1993 as an Assistant Corporation Counsel defending The City of New York against personal injury lawsuits.

Get the HURT911® Dream Team on your side!
Call Attorneys Rob Plevy & Phil Franckel days/nights/weekends for a free consultation
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No-Fault Denial – Why Isn’t No-Fault Paying My Medical Bill

Why did I receive a “New York Motor Vehicle No-Fault Insurance Law Denial of Claim Form” indicating that the No-Fault insurance company did not pay my doctor’s bill?

If you were in a car accident or a pedestrian hit by a car, you will receive a New York Motor Vehicle No-Fault Insurance Law Denial of Claim Form if you went to the hospital or saw a doctor.

We get calls all the time from people asking why the No-Fault insurance company didn’t pay the doctor’s bill and whether they are responsible for it.

Assuming that 1) you filed the application for No-Fault benefits on time; 2) your doctor sent the bill to your No-Fault insurance company within 45 days, and 3) your No-Fault benefits are still available, the Denial of Claim form is probably indicating that the doctor’s bill was paid.

Why No-Fault Denial of Claim Forms Are Confusing

What confuses everyone is that every time a medical provider gets paid by No-Fault, the insurance company sends you a No-Fault Denial of Claim Form even if the insurance company pays 100% of the bill.

No-Fault Denial of Claim Form

This No-Fault Denial of Claim Form shows $0 was paid. The explanation on the 2nd page said that was because the $200 deductible had not yet been used.

When you receive a No-Fault Denial of Claim Form, you should read the reason for the denial which is usually at the bottom of the first page with a further explanation on the second or third page. The explanation will tell you if the doctor billed too much; if your $200 deductible is being applied; or if you received medical treatment after you were denied further treatment.

Do I Have To Pay a Copayment Every Time I See a Doctor?

No. There are no co-payments for medical treatment paid by No-Fault when you are injured in a car accident.

Why Is No-Fault Refusing to Pay My Medical Bill?

To understand what the insurance company is doing with your claim, you must carefully read at the bottom of the No-Fault denial form where it says, “State reason for denial, fully and explicitly”.

Many people have a $200 deductible and this should be the only amount you are responsible to pay.

Most of the time No-Fault insurance will not pay the entire medical bill and the difference is indicated in box #32 Amount in Dispute. This is usually because the medical provider billed more than the allowed amount. Your doctor may send a bill for $300 but the No-Fault insurance company might only pay $78. The No-Fault insurance company is only required to pay the rate indicated on the Worker’s Compensation fee schedule.

Several months after your car accident, the No-Fault insurance company will have you examined by their doctor who may deny further medical treatment. Your No-Fault insurance company will have you examined by each medical specialty for which you have been treated.

For instance, if you have been treated by a chiropractor, orthopedic surgeon, and a neurologist, you will be scheduled for three No-Fault medical exams. If you are denied further treatment by a neurologist examining you for the no-fault insurance company, you can still see an orthopedic surgeon because they are in different medical specialties.

After going to a No-Fault physical examination, you will also receive a denial of claim form which may either deny all further medical treatment and benefits, deny further treatment from a particular medical specialty, or allow further medical treatment until a certain date. Again, you must carefully read the reason stated at the bottom of the form.

If, after a No-Fault exam, you have been denied further treatment and you continue to receive treatment for the denied medical specialty, you will become responsible for the medical bills. If you have been denied further medical treatment, we can still obtain medical treatment for you.

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Can I Pay My Doctor and Get Reimbursed by No-Fault?

If you paid the doctor at the time of treatment and submitted the bill to No-Fault yourself, you’ll be on the hook for the amount of the difference between what the doctor billed you and the amount that No-Fault will pay. The difference can cost you a lot of money. But there is no reason for you to ever pay a doctor directly. When the doctor bills No-Fault directly, the doctor cannot charge you for the difference.

How to Make Sure You Won’t Have to Pay Your Doctor for Medical Treatment When Injured in a Car Accident

  1. Ask the doctor if he or she accepts No-Fault.
  2. If the doctor does accept no-fault, you will be asked to sign a form that says “Assignment of Benefits”. YOU SHOULD SIGN THIS FORM. This form allows the doctor to get a directly from no-fault and you are no longer responsible for the medical bill as long as your no-fault coverage is still valid and you have not been denied further treatment. If you sign an assignment form, you are not responsible for the portion that was denied.

Do All Doctors Accept No-Fault As Payment for Medical Treatment?

No. Almost all doctors accept no-fault as payment for medical treatment. But there are some orthopedic surgeons and other doctors who do not accept No-Fault.

Plastic surgeons and dentists typically do not accept No-Fault. But if you need treatment by a plastic surgeon or dentist because of a car accident, we can almost always get your plastic surgeon or dentist to agree to accept No-Fault.

Will No-Fault Pay a Plastic Surgeon For Plastic Surgery?

Yes, and you do not have to pay in advance! But plastic surgery is handled very differently with no-fault than other injuries and you need to call us before you get treatment.

Your plastic surgeon will tell you that you have to pay in advance and get reimbursed by your no-fault insurance. If you do that, not only will you have to advance the money to your plastic surgeon but you will be reimbursed a lot less than you paid.

Will No-Fault Pay a Dentist for Dental Treatment?

Yes. But payment from no-fault for treatment of dental injuries is handled very differently than other injuries and you need to call us before you get treatment. Your dentist will tell you that you have to pay in advance and get reimbursed by your no-fault insurance. If you do that, not only will you have to advance the money to your dentist but you will be reimbursed a lot less than you paid.

If you need medical treatment by a plastic surgeon or dentist, you should call us immediately. We know how to get your plastic surgeon or dentist to accept No-Fault so you don’t have to pay any money out of pocket. Other personal injury lawyers we know, do not know how to do that.

If you were in a car accident or a pedestrian hit by a car, please call us for a free consultation.

Did the Insurance Company or Your Doctor Say Your No-Fault File Was Closed?

If you were told that your no-fault file was closed, you need to read why your no-fault file is probably not closed and how to reopen your No-Fault file.

See more FAQs

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Attorney Franckel is a well-known personal injury lawyer, Founding Partner of 1-800-HURT-911® New York, and a former Member Board of Directors of the New York State Trial Lawyers Association. He has an Avvo Top 10  Rating, Avvo Client’s Choice Award with all 5-star reviews, Avvo Top Contributor Award, Multi-Million Dollar Trial Lawyers Award, and other awards. See Mr. Franckel’s bio for areas of expertise.

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1-800-HURT-911® Personal Injury Lawyers "As Seen On TV" ABC, CBS, NBC, FOX, , WOR, WPIX logos

Get the 1-800-HUR-T911® Dream Team™ on your side and become a member of our family!

“Knowing I had a team of great lawyers on my side gave me a sense of power and peace of mind. They took care of everything for me. When a settlement was negotiated, I saw the difference a team of lawyers makes.”
—Lia Fisse

No Win — No Fee — No Expenses — Guaranteed!

Personal Injury Lawyer Screened by Google

Attorneys who can get you the most amount of money AND provide personal service!

Free Personal Injury Consultation call button  Chat to get your free Personal Injury consultation right now button

Please take a look at some of our:

What will happen when I call 1-800-HURT-911 or chat?

  1. Our call center operators and chat operators are available 24/7.
  2. Just give your contact info to our operator and Founding Partner Rob Plevy, Esq. will call you within 5-10 minutes for your free, no-obligation consultation during the hours of 8 am – 10 pm. After hours, Rob will call you in the morning or at the time you want.
  3. Then just text or call us any time you want during your case!

Because any delay could cause you to lose viable rights and benefits, please call HURT-911® Founding Partner Rob Plevy, Esq. right now for a free consultation to find out your rights days/nights/weekends.
1-800-HURT-911
1-800-487-8911

You can speak, text, or email with us whenever you want throughout your case and afterward, days/nights/weekends, and experience our famous personal service. You’ll even get our personal phone numbers so you can call or text anytime!

Watch Founding Partner Phil Franckel, Esq. talk about New York Serious Injury Attorneys.com, difficult cases, and the 1-800-HURT-911® Dream Team™


Philip L. Franckel, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York; He has a 10 Avvo rating; Avvo Client’s Choice with all 5-star reviews; Avvo Top Contributor; and a former Member of the Board of Directors of the New York State Trial Lawyers Association.

1-800-HURT-911® Founding Partner and Personal Injury Lawyer Rob Plevy, Esq.

Founding Partner Rob Plevy, Esq.

Robert Plevy, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York. Rob began his legal career in 1993 as an Assistant Corporation Counsel defending The City of New York against personal injury lawsuits.

Get the HURT911® Dream Team on your side!
Call Attorneys Rob Plevy & Phil Franckel days/nights/weekends for a free consultation
1-800-HURT-911

1-800-487-8911

New York Serious Injury Lawyer logo

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Have a Question or Comment About No-Fault Denial – Why Isn’t No-Fault Paying My Medical Bill? Leave a Comment!