Why were my No-Fault benefits discontinued? | No-Fault Series, Part 3: Termination of No Fault BenefitsJul. 28, 2022

Why were my No-Fault benefits discontinued? 

No-Fault Series, Part 3: Termination of No Fault Benefits

As discussed in part 2 of our No-Fault blog series, the No-Fault benefits offered through your auto insurance will be your first line of coverage if you are injured in an accident. Minnesota law requires your automobile insurance policy to provide a minimum of $20,000 worth of medical expenses coverage for reasonable, necessary, and accident-related treatment through your No-Fault benefits. However, there is a reason I say it "can be" covered instead of "will be."

There are many circumstances in which your auto insurance can dispute whether the treatment you are receiving is truly necessary or related to the specific injuries sustained in the accident. Your No-Fault adjuster carefully monitors the bills they receive for your treatment, and when they notice certain red flags, they can compel you to attend an Independent Medical Examination (IME).

An IME doctor is paid for and chosen by the insurance company with the goal of getting a medical opinion that favors cutting off your No-Fault benefits. Some folks call it an "Adverse" Medical Examination (or AME) because its purpose is to protect the financial interest of the insurance company. Your first instinct might be to skip it, but when an IME is requested, you are required by law to present to the appointment.

So what are the top 5 red flags that will have your No-Fault adjuster side-eyeing your medical care?

1. Delaying treatment until weeks or months after the accident.
   The more time that passes between the date of injury and the first date of treatment, the more leverage the insurance company has to argue that your complaints were unrelated to the accident.
2. Having a long lapse in care
   If you stop attending regularly scheduled treatment and return after many months - or more than a year - it becomes more difficult to prove that the care was necessary. A one-year lapse will almost certainly result in the benefits getting cut off.
3. Similar or identical complaints were made before the accident
   When your complaints of injury are the same or similar as complaints you've made before, your insurance company will argue that your current condition is pre-existing and unrelated to the accident (however, it is important to keep in mind that exacerbation of pre-existing issues is a legitimate claim in a personal injury case).
4. You fail to follow your doctor's follow-up recommendations
   The safest course is to follow your doctor's recommendations for further medical care and self-care to a T. When your medical records explicitly state that certain treatment was necessary, it is harder to challenge.
5. A long course of treatment yields no results.
   Let's say you go to the chiropractor to treat a diagnosis of muscle strain for 10 months and continuously rate your pain as 7/10 in severity. It will appear that the care is ineffective, or that you have reached your maximum medical improvement, such that more of the same treatment would be pointless.

If you present for an IME and the doctor's report results in your No-Fault benefits getting cut off, there is still some recourse for you to access that coverage. You may be able to file a claim for arbitration with the American Arbitration Association, so long as you continue treating your injuries. In the short term, however, No-Fault drops off as your first line of coverage, and your health insurance has to step in.

Although using health insurance can expose patients to additional out-of-pocket expenses such as copays, it is imperative that you continue to pursue appropriate treatment for your symptoms, as that is the only way to build up your bodily injury claim against the at-fault driver. In a well-documented case with lots of proof in the form of medical records, and lots of patience, you have the chance to make a financial recovery that will compensate you for all your accident-related losses.

If you have been injured in a car accident and have questions about what benefits you are entitled to through your no-fault benefits, please call for a free consultation. I would be happy to discuss your concerns. At Lord + Heinlein, we are your powerful legal voice.