Robin Herman | 25:19

New York no-fault covers medical bills until an insurance doctor cuts an injured bike rider off. What happens and how do you fight that?

Glenn Herman | 25:29

New York City attorney Glenn Herman warns that no-fault benefits end when the carrier’s own doctor says treatment isn’t necessary, but the deadline riders blow first is getting into the system at all. Under New York’s no-fault rules, which is insurance law 5102, if a motor vehicle hits you, you’re covered by that vehicle’s no-fault insurance policy. Now, that gives you up to $50,000 in medical bills, lost earnings, and that’s regardless of fault, but the application for the benefits has to be followed in 30 days of the crash. The riders lose this coverage constantly because nobody ever told them a bicycle crash triggers an insurance filing deadline at all. Often a lot of riders don’t even know that they’re covered under a car’s insurance if it’s an accident with a vehicle. Now, this cutoff somewhere around the fourth to eight months of treatment, the carrier sends you to see one of their own doctors. The exam is short, and that doctor writes that further treatment isn’t medically necessary, and then the insurance company uses that as a basis to deny all further treatment and the payment stop. All the physical therapy, the pain management, all cut off. That is not a medical finding that you’re healed. It’s an insurance coverage decision and it’s challengeable. Denial can go through arbitration, through the American Arbitration Association under Rule 68, and a denial that’s vague or legally deficient could be attacked on its own terms before you ever argue about the medicines. Meanwhile, you’re treating doctors very often will continue to treat you on a lean basis and get paid at the time of the eventual settlement. So your care doesn’t have to stop while that fight runs on.