The term “No-Fault” generally refers to the insurance policy that covers MVA’s (Motor Vehicle Accidents), which is the technical term for car accidents. It is called No-Fault because it does not matter whose fault the accident was. Whichever company insured the vehicle (car) you were in (either as a driver or passenger) is supposed to cover any medical expenses you may have as a result of the accident (up to a certain limit – normally $50,000). If you are a pedestrian that was struck by a vehicle, the insurance of that vehicle covers the medical bills. No-Fault cases are generally much simpler than Workers’ Comp cases. There are only a few forms you need to know. Furthermore, there is no No-Fault equivalent to the Workers’ Compensation Board and, as such, there are no hearings that you need to attend. There are, however, some similarities between No-Fault and Workers’ Comp. Namely, they are paid at the same rates (“fee schedule”) and both may involve the patient undergoing IMEs.
NO-FAULT (MOTOR VEHICLE ACCIDENTS)
TERMS AND COMMON FORMS
The below list of terms and forms is by no means inclusive. It is a rundown of the more important information for a case.
- NF-2 Form
Application for Motor Vehicle No-Fault Benefits. This is the form that is normally used to notify your insurance company that you were in an accident. You have 30 days to report the accident.
- NF-3 Form (click to see the info)
No-Fault Verification of Treatment Form. This is the form medical providers/doctors use to send a bill for medical services/treatment to your insurance company.
Assignment of Benefits. This is a form that the patient must sign in order to allow a medical provider/doctor to be allowed to bill their No-Fault insurance.
- Household Insurance
This refers to any No-Fault insurance policy a relative that you live with my have. If you were a passenger of a vehicle that did not have insurance at the time of the accident, you may normally be able to file a claim through the household insurance. The same applies to pedestrians that were struck by vehicles there were uninsured or by unknown vehicles.
Motor Vehicle Accident Indemnification Corporation. This is a non-profit organization which provides coverage to those without access to No-Fault insurance. You are eligible for coverage from MVAIC if you were a passenger of an uninsured vehicle, if you were a pedestrian struck by an insured vehicle, or if you were a pedestrian struck by an unknown vehicle (e.g. hit-and-run). Please note that if you have household insurance, you should first try to file a claim through that before filing one through MVAIC. For more information, please visit their website at www.mvaic.com.
Independent Medical Examination. This is a medical examination performed by a doctor that has a relationship with the insurance carrier. They can either be an employee of the carrier or they may be under contract with them and paid per case. This is something akin to a second opinion. It is usually done to ensure that the treatment the patient’s doctor is providing or requesting is necessary. A majority of No-Fault patients will be asked by the insurance carrier to undergo one or more IMEs. You must attend the IMEs or else your benefits may be cut off. The patient will normally be informed in writing that they must attend an IME. An IME doctor would state whether they believe a patient requires additional treatment or not. The IME may also address other issues such as whether certain testing or procedures were/are necessary and if certain parts of the body were in fact injured.
Sometimes medical bills stop getting paid, usually after a patient undergoes an IME that states that they do not need further treatment. Issues with unpaid medical bills are then resolved through the AAA (American Arbitration Association). The AAA resolves disputes between doctors and insurance companies on what medical bills should and should not be paid.
RELEVANT INFORMATION AND TIMEFRAMES
*Please note that it is important to get a police report of the accident.
- You have 30 days to report the accident to your insurance company. The best way to do this if through the NF-2 form. They may ask for a copy of the police report.
- If you sustain lost wages due to the accident, you have 90 days to submit a claim for lost wage benefits to the insurance carrier.
- Aside from any benefits you are entitled to through No-Fault coverage, you may also be entitled to additional compensation through a possible lawsuit against the person (driver) responsible for the accident. Obviously, an attorney would be required for such a lawsuit.
- If you are a passenger of a vehicle (or a pedestrian hit by a vehicle) that did not have insurance at the time, you may file a claim through your household insurance. If you do not have any household insurance, you may file a claim through MVAIC. The same applies to pedestrians struck by vehicles but do not know which vehicle (such as during a hit-and-run accident).
- Drivers and passengers of motorcycles involved in accidents are NOT eligible for No-Fault benefits. However, pedestrians struck by motorcycles ARE eligible.