So why are you now receiving a denial of claim from the no-fault insurance company denying the doctor’s bill? Assuming that you filed the application for no-fault benefits on time; your doctor sent the bill to your no-fault insurance company on time; and your no-fault benefits are still available, the Denial of Claim form is probably indicating that the doctor’s bill was paid.

When a no-fault insurance company sends a payment, they use a standard denial of claim form. Often, the no-fault insurance company will not pay the entire medical bill. The no-fault insurance company is only required to pay the rate indicated on the workers compensation fee schedule. Your doctor may send a bill for $300 but the no-fault insurance company may only pay $100. If you signed an assignment form when you first visited the doctor, you are not responsible for the portion that was denied.

When a portion of the payment is denied by the no-fault insurance company, a denial of claim form is appropriate. However, even if the no-fault insurance company pays 100% of the bill submitted by your doctor, the insurance company will still send notification of the payment on a denial of claim form, thereby causing unnecessary confusion. To understand what the insurance company is doing with your claim, you must carefully read at the bottom of the no-fault denial form “State reason for denial, fully and explicitly”.

After going to a no-fault physical examination, you will also receive a denial of claim form which may either deny all further medical treatment and benefits, deny further treatment from a particular medical specialty, or allow further medical treatment until a certain date. Again, you must carefully read the reason stated at the bottom of the form.

Before January 1, 2003, you could sue your spouse for your injuries if you were a passenger in a car being driven by your spouse and he or she negligently caused a car accident in Queens. After that date, you can only sue your spouse if you purchase optional Supplemental Spousal Liability coverage.

When you purchase car insurance or at your policy renewal, your insurance company will provide you a notice of availability of Supplemental Spousal Liability coverage, an explanation of it and the amount of the additional premium. Supplemental Spousal Liability coverage is inexpensive and must be offered as optional coverage by your insurance company for most motor vehicle insurance policies (where such policy is used for the purposes of satisfying the requirements of Article 6 of the Vehicle and Traffic Law), but is not included in your policy unless you specifically request it and pay for it.

If you do not purchase Supplemental Spousal Liability coverage and you cause an accident injuring your wife and friend, your friend can recover money for the injuries sustained, but your wife cannot. However, your wife will still be entitled to No-Fault benefits.

Supplemental spousal liability insurance merely allows you or your spouse to recover money for injuries as any other injured person could. This means that the injured spouse must still prove the negligence of the insured spouse who was driving.

Supplemental Spousal Liability insurance coverage does not increase liability insurance limits, but only adds another person to the liability coverage. For example, where your bodily injury coverage limit is $250,000/$500,000 and $100,000 is paid to your spouse, $400,000 is left to pay all other persons injured, subject to a maximum of $250,000 per person.

When you buy car insurance directly from an insurance company, the sales representative is a salesperson who is not required to give you advice. When you buy car insurance, be sure to buy from an independent insurance agent who will provide you with unbiased professional advice.

If you have been hurt in a Queens car accident, please call Queens Car Accident Attorney Phil Franckel, Esq. immediately for a free consultation at 1-800-HURT-911.