- 1 Q. My doctor says my No-Fault file was closed. Can I reopen my no-fault file?
- 2 How Insurance Companies Close Your No-Fault File
- 3 What Happens When Your No-Fault Insurance Company Closes Your No-Fault File?
- 4 Why Do Insurance Companies Close Your No-Fault File?
- 5 How Can I Reopen My No-Fault File?
- 6 Are There Other Reasons My No-Fault File May Be Closed?
Q. My doctor says my No-Fault file was closed. Can I reopen my no-fault file?
A. Yes. This is a common and unscrupulous trick insurance companies use to prevent you from getting medical treatment! If you have been told your No-Fault file was closed, it probably is not closed.
How Insurance Companies Close Your No-Fault File
Insurance companies “close” no-fault files for inactivity. A no-fault file becomes inactive if they don’t receive a bill for medical treatment within a few months and the insurance company simply “closes” your file.
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.
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.
Are There Other Reasons My No-Fault File May Be Closed?
Your no-fault file can technically only be closed if it paid out all of the money that was available.
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.
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.
Unfortunately, you should never file a lawsuit or arbitration to contest a no-fault denial until after your personal injury case has been settled.
However, we have been successful in getting the no-fault insurance company to reverse a denial when our client needed surgery.
See more reasons why no-fault may be denying your medical bills.
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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.