Types of Accidents
The purpose of this discussion today is to go over all the different types of actions. Now, in terms of the focus recently has been on workers’ compensation and no-fault accidents. Those are a subtype of the type of accidents and the location where they can occur.
Workman compensation primarily deals with injuries that are resulting from somebody that is injured during the scope of employment. Workers’ Compensation generally is set up, so that employees do not sue their employers at the time that they are injured. When an employee is injured at work, they pursue workers’ compensation coverage so that their medical bills are paid, as well as their lost wages.
An employee can have a third-party case sometimes in addition to workman compensation. Although workman compensation says that employees cannot sue their employers, they can sue anybody else (third party). Let us just assume that you work for a restaurant, and at the restaurant, you are walking, and you slip and fall and you fracture your leg and as a result, you need surgical treatment, now, assuming that this happened during the course of your employment while you were on the clock.
At that time, you cannot sue your employer; however, assuming that the mopping was done not by an employee of your employer, but by a third party company. At that point, you can pursue the third party company and sue them because they negligently failed to warn you of the dangers, which is the floor was wet, or that they negligently mopped.
So in that instance, you can go to the employer, but you can still sue a third party for your injuries. Another example is as follows, assuming that you are a taxi driver, and you are struck and hit by a vehicle from behind and you need medical attention, there is something known as the black car fund that is set up that is similar to workers’ comp.
But it says essentially that you cannot go through no fault, but you have to go to that fund because during the course of work and as a result, that is going to be primary for paying your medical bills; however, in that situation, you also have a third party case, which is another case against suing somebody, which is the person that rear-ended you. So that is called the third party case within the workers’ compensation case essentially.
Now with no-fault accidents that apply to automobiles and a lot of times if you are involved in a car accident, you have to use no-fault insurance as your primary insurance and if you are a pedestrian, the car that hit you is the primary no-fault. If you are in your friend’s car, the car that you are in is going to be your primary no-fault. If you are driving your own car, the primary no-fault is going to be your own insurance company.
Now a big concern people have is when I use my no fault, do my rates go up? The answer typically is nope. No-fault insurance is exactly what it sounds like. It is called no-fault, which means that irrespective of whose fault an accident is, your own insurance company is always required to pay for your medical bills and your lost wages.
That is the law that we have set up in the state of New York that may not apply to other states, but in New York state, our insurance rates are so high already, because we have no-fault insurance, which is medical pay protection and lost wage pay protection built into every policy.
Because the legislature decided that they do not want people in car accidents to worry about medical bills and lost wages instead they want them to pay for that protection in advance so that if they are involved in an accident, they do not become a burden of the state, and that the insurance companies pay for the medical bills and lost wages. So that is the philosophy behind why no fault is set up essentially.
Now, with no fault, they are required to pay the first $50,000 unless you have APIP, which is additional personal injury protection, which is an election in a policy that you may opt for at the time of buying your policy. It is always best to seek the independent advice of an insurance broker to make sure you have the best available coverages including additional personal injury protection so that if your medical bills exceed $50,000, you have additional funds, whether it be another 100,000 or 200,000, and protections to pay for your medical bills so that you are not paying out of pocket.
Now no-fault insurance will help an injured patient from a car accident to get treatment, whether it be chiropractic, physical therapy, acupuncture, orthopedic, neurology, and so forth. In the no-fault policy, there are also provisions built in and you know, for policies, essentially your insurance contract that you take out, you may say, wait, I do not have an insurance contract.
Because I called in and I got my insurance policy. Well, you can agree to a contract orally, or sometimes the insurance companies will send you an email and say please click here and consent. When you are consenting in that contract, you essentially agreed to the terms and conditions of the insurance policy. Now in the fine print of the insurance policy that applies to no fault, the car accident insurance will typically state that if you are ever involved in an accident, medical bills will be paid.
If they are reasonable and medically necessary and also, as a result of your no-fault policy and your insurance policy, they will require you normally to subject yourself to go see the insurance company doctors or known as independent medical examination doctors to determine when the treatment is medically necessary and to determine whether insurance companies are required to continue to pay your medical bills and lost wages.
They also have a provision in the policy that they can make you attend an examination under oath, which is also known as the EUO. A EUO essentially is an examination where they sit you down and ask you questions surrounding your policy, the treatment you receive, and so forth. The reason they can subject you to that is that they have the right to verify if you are actually receiving the treatment that you are receiving and whether you violated any policy conditions or not at the time you took your policy out, what is the typical violation of a policy?
Sometimes people get insurance policies and their registration and plate are for example in a state other than New York State, but they live in New York State. That is a policy violation and you would ask why? Because if you live in Pennsylvania, and you are paying Pennsylvania rates, which are substantially less than New York rates, but you really have your car in New York State, the insurance company did not sign up for that.
They quoted you a rate based on the fact that the car was going to be garaged in Pennsylvania, and now you live in New York State, which is a much more high-risk state and as a result, they did not charge you the premiums that they would have charged you. Now, when you take a new insurance policy, you would think that they would investigate where you live, but they do not.
A lot of time they will just blindly issue the policy based on what you tell them, but the time they start to investigate when they have to start now paying your medical bills and money out the policy, they look for reasons where how they can wiggle out of the policy and issue of policy violation denial and not pay for your medical bills and for your no fault.
Personal Injury accidents: Occasionally there can be a slip and fall like sometimes slipping on a foreign substance and that could be water or oil. Many other ways that you can slip due to someone’s negligence, which means that they fail to act as a reasonably prudent ordinary person would act in those circumstances in protecting you.
Also, you can trip on a defective curb or a pothole or you can trip due to an object left on the ground or you can slip due to something protruding from the ground up for example, construction was done at a mall and they put a signup and that sign broke but the metal rod of the sign is sticking out from the ground and you trip that is known as a trip and fall accident.
Motorcycle accidents: You may also have motorcycle accidents, which are not workers’ comp, and they are not no-fault accidents. Interestingly enough, no-fault law does not apply to motorcycle accidents. Why? because the legislature determined that motorcycles are inherently dangerous activity and as a result, their insurance companies are not required to ensure that risk and if someone’s involved in a motorcycle accident, they do not have the no-fault protection.
Their medical bills are usually paid through the private health insurance company or Medicaid or Medicare. If there is a personal injury case, when the case has been settled and resolved in court in terms of the injury case, we would normally have to call the individuals who have paid the medical bills and reimburse them as a result.
Elevator and escalator and Nursing home accidents: Other types of accidents and that we have our elevator accidents. Sometimes an elevator is misaligned or stopped short, or an elevator for some reason, malfunctions and causes someone injury while they are in the elevator.
At times we also have escalator accidents, someone going down an escalator and malfunctioning stop short, you fall forward and fracture a bone, or injure yourself. We also have nursing home accidents, in which if you are in a nursing home, you essentially entrust them with the care of the patient and it could be your mom or dad that are entrusted with the care of the nursing home, not the nursing home they are required to exercise all reasonable care and act them in a prudent manner to make ensure the safety and welfare and being of the individual that they take care of.
Now, sometimes the individual may be an elder patient who cannot get out of bed and as a result of negligent supervision, the personnel on duty may not be attending to the needs of the patient, and they may try to get out of bed and all of a sudden fall out of bed and fracture a bone. That is an action against the nursing home because they negligently supervised that person. So as a result, it can be actionable and you can pursue that.
Miscellaneous personal injury: Additionally, you also have dog bite accidents, you also have truck accidents and the list goes on and on in terms of how somebody can be injured. Someone can be operating machinery and all of a sudden that machinery malfunctions and now you have a product liability action, which is a lawsuit against the manufacturer of that device or that machinery, which turned out to be defective and you can go after them.