How to get your orthopedic treatment paid for with no-fault car insurance

No-fault insurance

Car accidents are among the most common causes of orthopedic injuries. If you were hurt in a crash, there's a good chance you need a bone doctor.

New York is a "no-fault" state for car insurance, which means everyone, regardless of fault, has access to coverage for their injuries. In principle, you'd think this would make it easier to get your treatment paid for. The truth can be somewhat more complicated. Here's what you need to know.

Who's covered by no-fault insurance?

In general, if you were a driver or a passenger in a car when the accident happened, you should be covered by the no-fault insurance of the vehicle you were in. If you were hit by a motor vehicle while you were walking or cycling, you're likewise covered by no-fault insurance. If you were on a motorcycle, either as an operator or a passenger, you are not covered by no-fault insurance. (Pedestrians hit by motorcycles are covered, though.)

There are a few other exceptions to no-fault coverage, including:

  • You were driving under the influence
  • You were driving in a drag race or speed test
  • You were driving in the commission of a felonious activity at the time of the accident
  • You were knowingly driving a stolen car
  • You were servicing or repairing a vehicle on the premises of a business that does vehicle repair (e.g. a garage or dealership)

How do I get no-fault coverage for my treatment?

Your first step is to notify the insurance carrier of the accident in writing. You have up to 30 days to do this, but we recommend doing so as soon as possible, for reasons we'll discuss in a moment. The insurance carrier will give you a claim number. When you arrive for your first visit, bring the claim number along with the date of the accident, your date of birth, and the insurance carrier's name. From that point forward, we'll bill the carrier directly for any treatment you need for the injuries you sustained in the car accident.

We strongly encourage you to see us as soon as possible after a car accident, and when you arrive, tell us about every symptom, even if it seems minor. A small pain could be indicative of a much more serious injury. The sooner we know about your injuries, the sooner we can make sure you get the treatment you need. Moreover, telling us about your injuries and your symptoms creates a record that we can use to verify that your injuries really were sustained in the car crash. Insurance carriers sometimes dispute whether a particular injury was accident-related, so creating that paper trail is critical. (This is also why you need to notify them of the accident as soon as you can.)

Keep in mind that there is no end date for the medical treatment portion of no-fault benefits - that is, as long as you still need treatment for an injury you sustained in the accident, it should be covered, up to the policy limit - but the need for future treatment must be medically ascertainable within a year of the date of the accident. For instance, if your injury is such that you might need future surgery, we have to ascertain that potential need within a year. As we're treating you, we keep this milestone in mind and provide a medical "forecast" if needed to ensure that your accident-related treatment will continue to be covered.

What about disability benefits?

No-fault insurance also provides some compensation for loss of wages if you're unable to work or need to work reduced hours or lighter duty due to the accident. Our role as your doctor is to examine you, verify the extent of your disability, and document it for both your employer and the insurance carrier so that you can get the reasonable accommodations you need at work and the compensation you're entitled to receive by law.

The key takeaways here: after an accident, document everything, get medical help, and move through the process as promptly as possible to ensure you get your no-fault benefits. If you've been hurt in a car crash,  contact us today to make an appointment.

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