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.
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
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.
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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.
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.