The Claims Process

Important: The No-Fault carrier should receive all letters and paperwork via certified mail with return receipt requested. As evidence of timely submission, keep copies.

An insurance will send you a package of forms to complete once they get your notification letter (within 30 days of the collision). Verification of medical care, hospitalization, income, and other factors may be among them.The NYS boilerplate forms reside here

(https://www.dfs.ny.gov/system/files/documents/2019/01/complete_nf_forms_2018.pdf. (Take note that while they are essentially comparable, these forms are not exactly the same as those an insurance may send you.)

Within 45 days of the date of service, you must provide the insurer with medical invoices (and specified proof) for treatment. Other expense bills must be provided within 90 days. According to the state’s 2012 No-Fault cover letter form, which is no longer accessible on the DFS website, if your No-Fault claim is approved and it is determined within the first year that you will require benefits for longer than a year, you are theoretically able to continue receiving them without restriction.

According to price schedules established by the state’s worker’s compensation board, the NYS commissioner of insurance determines what amounts are acceptable for health care. (NYIL §5108b) In certain instances, the insurer or arbitrator may grant charges above specified sums. (NYIL §5108a) These pricing schedules are typically known by hospitals and doctors.

If they consider the fees to be too low, some doctors can decline to accept No-Fault patients. Medical costs must be paid by the No-Fault insurance 30 days after receipt. Interest is charged at the rate of 2% per month on past-due bills. You are also entitled to a little payout for the cost of your attorneys’ expenses if the superintendent of insurance or an arbitrator reinstates your denied claim. (NYIL §5106)

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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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