Does a No-Fault Denial of Claim Form Mean Your Claim Was Denied?
You were injured in a car accident, went to the hospital and started seeing a doctor. You filed an application for no-fault benefits with your insurance company and now you received a form entitled “New York Motor Vehicle No-Fault Insurance Law Denial of Claim Form”.
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.