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Glynn Mercep Purcell and Morrison LLP

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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.