Auto Insurance Forum

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By A. Craig Purcell

A. Craig Purcell

As we embark upon a new year, it naturally prompts a period of introspection and planning. We have the opportunity to retrospectively examine the last 12 months, extracting valuable insights to help form our plans for the new year.

This thought process is not exclusive to personal reflection but extends to essential matters such as automobile and homeowner’s insurance. Conducting an annual review of some insurance components is advisable to ensure the best coverage. Given the prevalent spirit of setting and achieving resolutions during this peak season, why not proactively address a few insurance-related objectives?

To facilitate this process, we are pleased to offer a comprehensive insurance checklist for the new year, aiding you in navigating this crucial aspect of financial planning.

1. Compare rates: Do you believe you’re overpaying for auto insurance? You very well may be. But you’ll never know unless you do some comparison shopping. You should review your insurance policy to determine how your premium is trending. It is possible that despite maintaining an exemplary driving record, your premium may have experienced an increase. Alternatively, an unfortunate accident could have precipitated a significant spike. Participants in telematics insurance programs may observe regular fluctuations in premiums on a monthly basis, potentially necessitating a reconsideration if such uncertainty induces unease. Awareness of these subtleties helps you make well-informed decisions and guarantees that your insurance coverage meets your needs and expectations.

2. Find out how much it would cost to replace your home: Understanding your home’s replacement cost is a critical component of a homeowners insurance policy. This is also known as your dwelling coverage limit, and it determines the cost of repairing or replacing your home if it is damaged or destroyed.

It’s important to understand that the replacement cost is not the same as the market value of your home. You can’t just go to Zillow or another home valuation website and get an estimate for your house.

Furthermore, in order to be fully covered, your dwelling limit must be at least 80% of the rebuild value of your home. Otherwise, the insurer is only required to cover damages in proportion to the amount of coverage you have.

Several factors influence the cost of rebuilding your home. Consider the age and square footage of your home, the type of foundation and roof, local building and zoning codes, and any home additions or upgrades.

Given the likelihood of modifications or renovations to your home over the years, it is advisable to compute the replacement cost of your home annually. Likewise, promptly updating this valuation with your insurer, as necessary, is a prudent practice to ensure that your coverage aligns accurately with the current value of your property.

3. Keep an eye out for new exclusions: Even though insurance policies cover a wide range of situations, there are usually exclusions. A typical home insurance policy, for example, does not cover damage caused by natural disasters such as floods, earthquakes, or hurricanes. Certain insurance companies may also refuse to cover pets or may only cover certain breeds.

Check your policy for exclusions at the start of the year. It’s possible they were added without your knowledge. Exclusions could include large purchases such as jewelry, artwork, or electronics. If you notice an exclusion for something that concerns you, it may be worthwhile to purchase separate coverage.

4. It doesn’t hurt to ask for a discounted or reduced premium: Insurance providers extend discounts for a myriad of reasons, such as exemplary driving records, academic achievements, military service, and the bundling of auto and home insurance, among others. It is worth noting, however, that not all insurance companies offer identical discount structures. Indeed, many may not proactively communicate the full spectrum of available discounts unless prompted by a customer inquiry.

While exploring all your insurance options, it is prudent to proactively engage with your current insurer or prospective ones to inquire about available discounts. Whether you possess a commendable driving history, hold student status, or have a military background, it is advantageous to communicate these attributes during your inquiry.

Discount offerings may vary across different insurers, but it is not uncommon to secure substantial reductions on monthly premiums. This translates to noteworthy annual savings, potentially amounting to hundreds of dollars.

As the new year unfolds, filled with anticipation for what lies ahead, consider using this checklist to help usher in a more welcoming and financially prudent future.

A. Craig Purcell, Esq. is a partner at the law firm of Glynn Mercep Purcell and Morrison LLP in Setauket and is a former President of the Suffolk County Bar Association and Vice President of the New York State Bar Association.

By Shannon L. Malone, Esq.

Shannon L. Malone, Esq.

Over the course of the year, we at Glynn Mercep Purcell and Morrison LLP., have sought to inform our neighbors in the community of important automobile insurance topics through our Auto Insurance Forum column. To summarize the many insurance issues discussed in our articles and to help the reader understand some key takeaways, we suggest keeping the information below in a safe place so that you may reference it in the future. 

Insurance Policy Minimums under New York State Law: $25,000 per person/$50,000 per accident in Bodily Injury coverage; $25,000 per person/$50,000 per accident in Supplemental Underinsured Motorist (SUM) coverage; $50,000 in Personal Injury Protection coverage; $25,000 per person/$50,000 per accident in Uninsured/Underinsured Motorist coverage

The Importance of Adequate SUM Coverage: As discussed, SUM coverage is mandated in New York for the amount indicated above. Having adequate SUM coverage is vital to ensure fair compensation when injured by an under-insured driver as your own policy pays the gap between their liability and your claim.

Understanding the Motor Vehicle Accident Indemnification Corporation (MVAIC): In New York, “No Fault” insurance (Personal Injury Protection or PIP) covers accident-related costs, regardless of fault. Drivers need a minimum liability policy of $25,000. 

When hit by an uninsured driver or involved in a hit-and-run as a pedestrian, cyclist, or motorcyclist without your own insurance, the Motor Vehicle Accident Indemnification Corporation (MVAIC) steps in. MVAIC is a non-profit organization providing up to $50,000 in no-fault benefits for medical bills and $25,000 per person for injury compensation. 

It’s funded by insurance company levies, fees, investments, and recoveries. To qualify, the accident must be reported to the police within 24 hours, the accident must have occurred in New York, and no other insurance is available. You cannot own or be the spouse of the uninsured vehicle’s owner. For hit-and-runs, file a Notice of Intention within 90 days (180 days if the owner is identified). Complete an NF-2 form with accident and injury details, medical bills, and a Household Affidavit. Consult a lawyer for help navigating this process.

Understanding New York’s No-Fault Insurance Law: New York State Insurance Law § 5102(d) governs the criteria which allows you to make a claim or file a lawsuit when you are injured as a result of a motor vehicle accident. 

The section defines the criteria necessary to receive compensation (i.e., a serious injury) as: ”a personal injury which results in (1) death; (2) dismemberment; (3) significant disfigurement; (4) a fracture; (5) loss of a fetus; (6) permanent loss of use of a body organ, member, function or system; (7) permanent consequential limitation of use of a body organ or member; (8) significant limitation of use of a body function or system; (9) or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.”

Remember Insurance Companies are in Business to Make Money: Insurance companies aim to minimize payouts to maximize profits. They investigate claims, including personal background and online presence. Communicate factually with insurance adjusters but avoid volunteering information. Many companies use actuarial software to calculate low initial settlement offers. Negotiate to increase your claim’s value by considering all medical expenses, additional accident-related costs, and long-term consequences of your injuries.

On behalf of Glynn Mercep Purcell and Morrison LLP., we wish you a Happy Thanksgiving!

Shannon L. Malone, Esq. is an Associate Attorney at Glynn Mercep Purcell and Morrison LLP in Setauket. She graduated from Touro Law, where she wrote and served as an editor of the Touro Law Review. Ms. Malone is a proud Stony Brook University alumna.

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By A. Craig Purcell, Esq.

A. Craig Purcell, Esq.

So many Long Islanders, both young and old, ride motorcycles these days that we are constantly being asked about insurance coverage available for this exceedingly common means of transportation and recreation.

The first thing you need to know is that you can obtain motorcycle insurance, and more importantly, liability insurance for motorcycles is mandatory in the State of New York. This means you must insure your motorcycle in order to register it here.

What type of insurance is mandated for motorcycles? The motorcycle must have liability insurance in the minimum amount of $25,000, as is the minimum for all New York automobiles. The standard minimum coverage for both is as follows:

— $ 25,000 in bodily injury per person

— $ 50,000 in total bodily injury per accident

— $ 10,000 in property damage per accident while operating your motorcycle

This requirement means that if you are at fault for someone else’s injury, these are the minimum protections for your liability. Remember, these are only the state required minimum coverages, and higher coverage amounts are strongly recommended to protect your assets.

It is important to understand that no-fault insurance coverage (personal injury protection) is unavailable for motorcycles. This means that your medical bills will not be paid by your own insurance company. This differs from the policy covering your own automobile, which insurance coverage requires that your reasonable medical bills be paid by your own company even if the accident was your fault. 

As our first article in this series, “Only pay for what you need. The question then becomes: What do you need?” explained supplemental underinsured coverage is extremely important and mandatory for motorcycles, as well as automobiles. 

As emphasized in that article and throughout this series, obtaining more than the minimum amount of coverage available (as outlined above) is highly recommended and should be discussed with your insurance broker or insurance company.

In concluding our discussion concerning motorcycle coverage, we wish to emphasize our strong advice to resist the temptation to purchase the minimum coverage allowable in the state, and obtain more than the minimum coverage mandated. Do not let the additional costs persuade you from paying for what you and your family really need to protect your assets and give you peace of mind.

Please see our March and April columns explaining what No-Fault Insurance coverage means for you and your family in addition to our June column discussing the MVAIC and its applicability to motorcyclist’s claims.

A. Craig Purcell, Esq. is a partner at the law firm of Glynn Mercep Purcell and Morrison LLP in Setauket and is a former President of the Suffolk County Bar Association and Vice President of the New York State Bar Association.

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By Shannon L. Malone, Esq.

Shannon L. Malone, Esq.

Members of the community have been inquiring about how the courts have dealt with their calendars for personal injury cases caused mainly by motor vehicle accidents during more recent variants of COVID-19. Clients are naturally concerned about their health and the progress of their personal injury cases. 

Moreover, people who have gotten into various types of accidents while last year’s Omicron variant was raging wonder if they, or we, should be doing anything different. Finally, with the recent uptick in COVID-19 reported by the media, we are receiving additional inquiries of this nature over the summer. 

Just ‘how open’ were the courts before the Omicron variant became widespread?

Before the Omicron variant of the COVID-19 virus became prevalent, the courts in Suffolk County and throughout the state were beginning to “open up” and conduct “in person” appearances for conferences and other matters. 

Trials started when these appearances became more commonplace and seemingly conducted without danger to the court personnel, litigants, and lawyers. First, the court scheduled criminal trials in cases with incarcerated defendants, and then serious felony trials began in the fall of 2021. 

Next, the court started trying civil cases as a backlog of personal injury accident trials had developed. The judges throughout the state were encouraged to reduce the backlog, as it is well known that personal injury cases arising out of car accidents, slip and fall incidents, and medical malpractice usually settle only when a trial is about to begin. Therefore, the need to schedule trials became essential. 

What happened to trials that were scheduled before the Omicron variant became widespread? 

Just as civil trials for personal injury cases were beginning to be held with little or no noticeable spread of the virus, by the end of 2021, the Omicron variant hit New York State and most of the country. 

Several personal injury trials had been completed by jury verdict or settlement in Suffolk County; however, as 2022 began, the Omicron variant caused a pause in starting most civil personal injury trials. While a few such cases proceeded to trial while Omicron was spreading, the cases that involved several parties, such as multi-car accident matters, were postponed until the variant subsided.

What is the status of personal injury cases as of the Summer of 2023? 

Despite the emergence of the apparent new strain of COVID-19, the entire country clearly is enduring its spread. Whether it is a result of the vaccines, people developing immunity, or the availability of medications, most cases seem to be relatively mild. As a result, the courts are operating as they were in 2019, and trials are proceeding in virtually all personal injury cases. 

Needless to say, if you have a case pending or were involved in an accident that caused personal injury, be sure to keep in touch with your lawyer or consult with an attorney if you haven’t done so already, as no one can predict how new variants of the virus will evolve. 

According to epidemiologist Nathan Grubaugh of Yale University, “Delta was never going to be the last variant—and Omicron is not going to be the last one, as long as there is a COVID-19 outbreak somewhere in the world, there is going to be something new that emerges.” 

Shannon L. Malone, Esq. is an Associate Attorney at Glynn Mercep Purcell and Morrison LLP in Setauket. She graduated from Touro Law, where she wrote and served as an editor of the Touro Law Review. Ms. Malone is a proud Stony Brook University alumna.

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By A. Craig Purcell, Esq.

A. Craig Purcell, Esq.

In our last column, we outlined the criteria for eligibility to seek compensation or monetary damages for injuries you sustained in an automobile accident due to another driver’s negligence. We also explained the initial steps necessary to make such a claim. Now it is time to discuss how to evaluate your claim and negotiate with the insurance company insuring the at-fault party who caused the accident. 

Indeed, the first question we, and other lawyers, are often asked is, “How much is my case worth?” Although cliché, the answer is virtually always “It depends.” The truth is that there is no simple or easy answer to this inquiry, nor is there a tried-and-true method to develop a reasonable value for a given case. There are simply no established valuations for any particular injury, no charts to refer to, or answers even Siri can provide you. Among the many criteria for estimating a case’s value are the following:

• The severity of the injury itself

• Permanent disability due to the injury

• Age and occupation of the injured person

• If employed, time missed from work

• Ability to perform functions for daily life in the future (i.e., household chores)

• Ability to enjoy recreational activities, such as sports, that you participated in prior to the accident

• Expenses not paid by your No-Fault insurance carrier.

Several additional factors are considered when evaluating a particular claim; however, those enumerated above are the most important. For example, if the injured person is a construction worker who hurts his or her back in a motor vehicle accident, the effect may be a long period of time out of work. A computer operator who suffers a fractured hand or wrist and develops carpal tunnel syndrome may be disabled for longer than someone in a different position. The same goes for a doctor, electrician, or many other professions. In conjunction with these issues, the pain and suffering caused by the injury leads claimant’s attorneys and insurance companies to come up with monetary damage ranges and amounts.

While this is clearly far from an exact science, lawyers who handle personal injury automobile accident cases have many references they can utilize to evaluate these cases. These include publications reporting recent jury verdicts around the state for particular injuries or even significant settlements. Thus, the personal injury practitioner can get a sense of how much a claimant may expect to receive for a particular injury in each county in New York State, or what an insurance company would be willing to pay for such injuries. 

However, the exact amount your case may be worth is highly subjective and unique to your specific circumstances. Therefore, the claimant and their attorney must discuss the above criteria applicable to the case and start negotiating with the insurance carrier. 

It must be understood that insurance companies are under no legal obligation to pay a claim, although if they do negotiate, they must do so in good faith. This basically means that the insurance company runs certain risks if it makes woefully inadequate offers to settle your claim.

Our next column will answer more often-asked questions, like “Why do I need so much automobile coverage, if I have homeowners’ insurance or an umbrella policy?”

A. Craig Purcell, Esq. is a partner at the law firm of Glynn Mercep Purcell and Morrison LLP in Setauket and is a former President of the Suffolk County Bar Association and Vice President of the New York State Bar Association.

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By Shannon L. Malone, Esq.

Shannon L. Malone, Esq.

In this column, we have previously discussed several issues concerning, and resulting from, automobile accidents. This included No-Fault Insurance, Underinsured and Uninsured Motorist coverage, the amount of insurance you should purchase to protect yourself, and the Motor Vehicle Accident Indemnification Corporation (MVAIC). Yet, the question occurring to most accident victims is, how do I seek compensation for my own injuries when I was not at fault for the accident?

Under what circumstances can you make such a claim?

New York’s No-Fault Insurance Law governs the criteria which enables you to make a claim or bring a lawsuit. We explained previously that this law has provisions covering the payment of medical bills and other expenses. However, this law, specifically § 5102(d) of the New York State Insurance Law, affords you the right to make a claim when you are injured. This section defines and outlines the criteria necessary to receive compensation (i.e., a serious injury):

— a personal injury which results in (1) death; (2) dismemberment; (3) significant disfigurement; (4) a fracture; (5) loss of a fetus; (6) permanent loss of use of a body organ, member, function or system; (7) permanent consequential limitation of use of a body organ or member; (8) significant limitation of use of a body function or system; (9) or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.

What does this definition mean, and how does it affect my ability to bring a claim or lawsuit? If, for example, you sustained a fractured bone, the permanent loss of the use of a body part or organ, or if you meet any of the other provisions outlined above, you have met what is commonly called the “No-Fault Threshold,” enabling you to obtain compensation.

In order to start the process of making such a claim, you must contact the insurance company for the vehicle that caused the accident. The primary insurance company is that of the at-fault driver. You can identify this company from a three-digit code contained in the police report prepared by the officer responding to the scene of the collision.

Please note that if you are physically able to, calling the police at the scene of the accident is extremely important. Notifying the police later on, as soon as you can, is crucial. When you contact the responsible insurance company or that company’s representative contacts you, you will be provided with a claim number to use for all future communications. 

Now you are ready to make a formal claim! In speaking to the responsible insurance carrier, describe your injuries in detail but do not explain how the accident occurred. Remember, whatever you say can be used against you later on if you say too much. Put most simply, you need to advocate for yourself by documenting your injuries and their necessary treatment but be careful what you say at all times. At this point, the monetary “value” of your claim becomes the principal focus and issue. If you have not retained the services of a lawyer at this point, it is strongly urged that you do so.

In our next column, we will endeavor to explain how a claim is evaluated so that decisions can be made as to whether to accept any offers the insurance company may make as a result. 

We, in closing, highly recommend that you precisely document your injuries and follow up with an experienced adjuster, advocate, or attorney to assist you in going forward with your claim.

Shannon L. Malone, Esq. is an Associate Attorney at Glynn Mercep Purcell and Morrison LLP in Setauket. She graduated from Touro Law, where she wrote and served as an editor of the Touro Law Review. Ms. Malone is a proud Stony Brook University alumna.

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By A. Craig Purcell, Esq.

A. Craig Purcell, Esq.

After an automobile accident, you should always stop and notify the police. Indeed, under New York State (NYS) law, anyone involved in an accident must stop at the scene, and if the accident caused injuries or significant property damage, it is very important for you to notify your insurance company right away.  

A car accident can have far-reaching consequences on everyday life for you and any other driver or passenger involved. Although an accident may occur within the blink of an eye, the subsequent negative impacts on an injured person’s ability to work and perform daily activities may continue well into the future. This may potentially jeopardize the health and financial security of all parties involved in the accident (driver, passenger, etc.). The property loss that may be sustained may pale when compared to the severe bodily harm from a crash.

As we have discussed previously, New York imposes the following minimum amounts for liability coverage:

• $10,000 for property damage coverage (PDL) from a single accident

• Bodily injury coverage (BIL) of $25,000 per person and $50,000 for all persons injured

• Death coverage of $50,000 per person killed in an accident and $100,000 for all persons killed in an accident

• No-Fault coverage of $50,000

Types of Automobile Liability Insurance

Liability insurance covers damages if someone makes a claim against you for loss or harm as a result of your negligence. Your insurance provider protects you and reimburses the individual who made a claim against you up to the extent of your coverage. In addition to being required by law, liability insurance is crucial to avoid out-of-pocket losses.

If you cause a car accident, your liability insurance, specifically your bodily injury liability policy, will pay for the injured parties’ pain and suffering or permanent injuries after a settlement is reached or a personal injury verdict is rendered. Remember, NYS only mandates that you hold accident coverage of $25,000 per individual. This amount should be increased to protect you and your assets, so paying for a policy that at least provides $100,000 per individual and $300,000 per accident in coverage for all injured persons is essential, and more is strongly recommended 

So how much liability coverage is enough?

As much as you can reasonably afford. Don’t scrimp on liability coverage when deciding how much auto insurance you need. Doubling liability coverage does not mean you will pay twice as much for the additional protection. Low liability limits place your savings and assets at risk should you cause an accident, making it imperative that you purchase as much liability insurance as you can. This is especially so because medical expenses are constantly increasing. 

High liability limits protect you if you cause an accident and prevent you from possibly having to sell your home to cover accident costs caused by a severe injury to the other party. Therefore, it is crucial that you assess whether your liability limits accurately reflect the assets at risk should an accident occur due to your negligence.

A. Craig Purcell, Esq. is a partner at the law firm of Glynn Mercep Purcell and Morrison LLP in Setauket and is a former President of the Suffolk County Bar Association and Vice President of the New York State Bar Association.

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What all cyclists should know

By Shannon Malone, Esq.

Shannon L. Malone, Esq.

If you have read our previous articles, you know New York is a “No Fault” state requiring all vehicle owners to have Personal Injury Protection insurance (PIP). PIP provides coverage for costs sustained as a result of a motor vehicle accident, such as medical bills, medications, transportation costs, and other expenses, regardless of who is “at fault” or who caused the accident. The law also provides that all owners of motor vehicles keep a minimum liability insurance policy of $25,000 to cover injuries to other drivers caused by their negligence.

But what happens when a driver with no insurance causes an accident or you are hit by a driver who leaves the scene before being identified? What happens if you are a pedestrian, bicyclist, or motorcyclist and do not carry your own automobile insurance policy? 

Fortunately, the Motor Vehicle Accident Indemnification Corporation, or MVAIC, provides New Yorkers with an alternative way to be compensated. Article 52 of the New York State Insurance Law established the MVAIC to cover No-Fault and injury claims when no other auto liability insurance is available.  It was established in 1958 by the New York State Legislature in enacting Article 17-A (now Article 52) of the New York Insurance Law.  MVAIC operates as a non-profit organization and provides no-fault benefits of up to $50,000.00 to cover your own medical bills and provides up to $25,000.00 per person as compensation for anyone injured in a crash. 

The MVAIC is funded through levies on insurance companies providing automobile liability insurance in the State of New York in accordance with Section 5207 of the Insurance Law. Other sources of funds include fees collected from self-insurers by the New York State Department of Motor Vehicles under Sections 316 and 370-4 of the Vehicle and Traffic Law, investment income, and subrogation recoveries.

There are distinct requirements to qualify for MVAIC Benefits. (1) You must report the accident to the police within 24 hours; (2) there mustn’t be any other car insurance available to cover the loss; (3) the accident must have taken place in New York. (4) Additionally, you cannot own the uninsured car or be the spouse of the uninsured vehicle’s owner. 

For hit-and-run accidents, you must file a Notice of Intention with the MVAIC to file a claim within 90 days of the accident. If the uninsured vehicle’s owner was identified, you must file this notice within 180 days of the accident. Next, you must file an Application for Motor Vehicle No-Fault Benefits or an “NF-2” form which requires a description of the accident and your injuries, the names and addresses of the doctors who treated you, and the treating hospital. You will also need to submit an accounting of your medical bills resulting from the accident and those anticipated in the future. Finally, you must complete a Household Affidavit, which states where you lived and who lived with you at the time of the accident. 

When the MVAIC receives your application, it opens a case file and initiates an eligibility review. As part of the process, an MVAIC claims examiner may interview you, and the MVAIC will notify you whether your application is confirmed or denied.

It is crucial that all cyclists and pedestrians familiarize themselves with the application process and the deadlines detailed above after becoming involved in an accident with a vehicle that leaves the scene of the incident and consult with a lawyer to help process this little-known application.

Shannon L. Malone, Esq. is an Associate Attorney at Glynn Mercep Purcell and Morrison LLP in Setauket. She graduated from Touro Law, where she wrote and served as an editor of the Touro Law Review. Ms. Malone is a proud Stony Brook University alumna.

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By A. Craig Purcell, Esq.

A. Craig Purcell

In our two last columns, we wrote about the necessity of obtaining adequate SUM (Supplemental Underinsured Motorist) and UM (Uninsured Motorist) coverage in the event you are seriously injured in an automobile accident due to the negligence of a driver who has a limited liability insurance policy, or no insurance at all. We encouraged you to ascertain the amount of SUM and UM coverage you have paid for as part of your own automobile insurance policy, to make sure your policy adequately protects you in this unfortunate event.

A question we are almost always asked by our clients who have been injured in an automobile accident, is “how do my medical bills get paid? Are they paid by my health insurance carrier, Medicare if I am over 65 years of age, Medicaid if I am a Medicaid recipient, or in some other way?” Many people simply show their insurance card, Medicare card or Medicaid card when they are brought to a hospital emergency room, go to a walk-in facility or a doctor’s office without further thought.

NO-FAULT INSURANCE

If you are injured in an automobile accident, you should be relieved to know that your reasonable medical bills will be covered by your own automobile insurance carrier under the No-Fault provision of your insurance policy. This is listed on your policy as “PIP” (personal injury protection). The reason this provision in your policy is known as No-Fault Insurance is that your own company is obligated to pay your reasonable medical expenses, even if you caused the accident. 

Many, if not most, hospitals, walk-in clinics and other healthcare providers simply ask the patient or their family for the insured’s health insurance information, even when the provider is told that the injury was caused by an automobile accident. This often leads to confusion and even disputes concerning what entity is responsible for the ensuing medical bills.

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While it may be difficult to provide a hospital emergency room with your automobile insurance information, it is important for you or your family member to provide that information at your doctor’s office or walk-in facility right away. Likewise, the same is true for the offices of your physical therapist, chiropractor, pain management specialists or any other health care provider. 

In addition to the confusion and the possibility of disputes over payment of medical bills arising out of injuries from your accident, certain insurance providers, as well as Medicare and Medicaid, may have a lien on any recovery you obtain for your pain and suffering from the insurance company for the driver who caused the accident. The beauty of No-Fault Insurance is twofold.

First, your medical bills get paid regardless of whether you or the other driver caused the accident and second, your No-Fault Insurance company does not have a lien or claim against any recovery you might obtain.

Finally, with regard to No-Fault Insurance, it is important that you speak to your insurance agent or carrier about the amount of this coverage you have with your policy. The mandatory (minimum) amount of No-Fault, or PIP, Insurance in New York is $50,000. However, if you sustain a very serious injury in an automobile accident, your medical bills may well exceed $50,000.

Therefore, just as in ascertaining how much SUM or UM coverage you have in your insurance policy, you should consider paying for No-Fault coverage above the $50,000 minimum. This would protect you against your automobile insurance company asserting a lien against any recovery you obtain because it paid medical bills in excess of the minimum. It would also often avoid having Medicare, if you are over 65, pay any bills in excess of $50,000.00, which could also result in a lien against any recovery you obtain from the insurance company for the driver who caused your accident.

A. Craig Purcell, Esq. is a partner at the law firm of Glynn Mercep Purcell and Morrison LLP in Setauket and is a former President of the Suffolk County Bar Association and Vice President of the New York State Bar Association

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By Shannon L. Malone, Esq.

Shannon L. Malone, Esq.

Last month we explained in some detail what benefits New York automobile owners/drivers enjoy under its No-Fault Insurance Law. We also enumerated the instances where a motorist is not covered by the No-Fault Law. Today we explain how your No-Fault Insurance Application is processed by your insurance company and what rights you have under the New York No-Fault law.

The first crucial thing to remember is that you keep a copy of your No-Fault Application after you have filled it out, before you send it to your insurance carrier. If you have already consulted with or retained a lawyer, you should email your completed application to your attorney so he or she has the opportunity to make suggestions or approve the application.

After your application has been filed, you should receive a communication in writing from your insurance company acknowledging receipt. The insurance carrier should have already assigned what is known as a No-Fault claim number to your file, and the name and contact information of the representative who has been assigned your claim. 

If you do not receive such an acknowledgment within approximately 10 days of the date you filed your No-Fault Application, you should follow up by contacting the company. Anytime you speak to a representative, you should be sure to obtain their name and all their contact information.

What other obligations do I have in order to obtain or keep no-fault benefits?

Your automobile insurance policy requires you to cooperate with your insurance company at all times. This cooperation comes in several forms. Your claim representative may contact you with questions about the forms you have submitted. You must answer his or her questions, after you ascertain that they are actually a representative of your company. 

The insurance company representative often wants to ask you about your injuries and treatment, and you are obliged to respond. You should, however, be very careful in responding, as your insurance company has to the right to deny coverage for certain treatment it deems unnecessary.

Therefore, you should include all of the injuries you believe you have sustained and complained about to your physicians or other health care providers.

Your No-Fault Insurance representative will probably ask you exactly how the accident happened. Even though your own insurance company is obligated to pay your reasonable medical and out-of- pocket expenses regardless of fault, its representatives are permitted to ask about the accident. You should be careful describing the accident, as what you say may end up being discovered by the insurance company for the other driver and used against you.

Further, your insurance company is entitled to have you examined by a doctor of its own choosing after a certain period of time has elapsed. This is so it can have a doctor confirm your injuries and treatment plan. These doctors often recommend that the No-Fault carrier pay for a certain amount of visits to, for example, physical therapists, chiropractors, acupuncturists and specialties of various kinds. This examination is known as an IME (independent medical examination), but we contend that there is nothing independent about it. The doctor who examines you gets paid by your insurance company to render an opinion, so he or she may have a bias against recommending further treatment, or any treatment at all. Nonetheless, you must cooperate by submitting to these exams. 

Your lawyer can often intervene to set the time and place of these examinations so they are convenient for you and may attend if it is warranted.

What can I do if the No-Fault carrier denies coverage for, or limits, my treatment? 

There are several remedies you and your lawyer have in that situation. These will be discussed in our next article concerning No-Fault Insurance.

Shannon L. Malone, Esq. is an Associate Attorney at Glynn Mercep Purcell and Morrison LLP in Setauket. She graduated from Touro Law, where she wrote and served as an editor of the Touro Law Review. Ms. Malone is a proud Stony Brook University alumna.