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.
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 to not 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.
Phil Franckel is well-known in New York and has been a personal injury lawyer since 1989. He is a Founding Partner of 1-800-HURT-911, LLP®, the Personal Injury Dream Team™, 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 others. See Mr. Franckel’s bio for areas of expertise.
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