Wednesday, February 22, 2012

No Fault And Doctor's Appointments: Some Basics You Should Know

If you were hit by a car in a No Fault state the first thing you need to know is that you can, and should go to any provider of care that accepts No Fault.  In New York this includes orthopedists, chiropractors, and acupuncturists.  You do not need prior approval, a referral, or have to choose from a list of pre-approved doctors as you would with an HMO or Workers Comp.  You do not need to contact the insurance company--in fact you should never speak to them directly unless your lawyer says you have to.

This is important not only so that you can get the proper care as soon as possible, but because it also supports your case against the driver's insurer and possibly the driver if you cannot receive an acceptable settlement from the insurer.  Remember, the auto insurer has claims people whose job is to reduce the amount of money they need to pay for your injuries.  The insurer would really love it if you didn't go to the doctor, they had their Independent Medical Examiner look at you, and then they could cut you off from receiving any medical care AND reduce the amount of liability money you would have received otherwise.

So in my case for instance, I was told at the Emergency Room the day I was hit that I should go to my regular doctor a week later for a follow-up.  Instead, I went straight to the orthopedist.  I went to the front desk and simply asked, "Do you take No Fault Insurance?"  They said yes, and I made an appointment.  If I had gone to my regular, general physician he probably would not have realized how badly injured I was, or referred me surgeons--and even if he did, for lack of a specialty his diagnosis would not have carried as much weight.

If that doesn't convince you, consider this.  When the insurer sent me to an Independent Medical Examiner, they sent me to an orthopedic surgeon; he was a quack who just denies claims all day, but he was a surgeon.  If the insurer feels they need a surgeon to deny your claim or cut you off from care, then certainly you need a surgeon on your side.  And it's paid for by No Fault, so you really have no reason not to see a surgeon.

The other main thing you need to know is that you can go to as many doctors as you like, but you can't go to two of them in the same day.  This includes Physical Therapy.  So in my case I can't go to a chiropractor or go to a follow-up with the surgeon and go to Physical Therapy on the same day.  So if you are receiving care from multiple sources, make sure to schedule them out.

Also don't let a lapse of time go between getting care and simply resting.  If you're not receiving treatment for a time, this indicates to the insurers--including Disability or Workers Comp--that you no longer need care.  As hard as it is to keep going, as much as you would love to take a month off from getting electrocuted, stabbed with needles, going to Physical Therapy, and getting your bones manipulated, you can't stop until you are 100% and ready to go back to your normal life.

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