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Medial Care Through “No-Fault” – Quick Claims Cure Diagnosis Delays

December 12, 2011

A question people often ask after a car crash is “I didn’t go to the emergency room after the crash, now I’m in pain days later. Am I still covered by no fault insurance?”

The short answer is yes, provided you have submitted a timely no-fault claim. No-fault insurance is extended, in general terms, to everyone who is injured during the use, operation, or maintenance of a motor vehicle. If you were so injured, you have thirty days to submit a no-fault claim regardless of whether you have insurance of your own. Wisdom suggests that any injury, bruise or break, should be listed on the claim because you don’t know which injury will require the most medical attention. No-fault insurance is responsible for physical injuries and money losses you sustained due to the use of a motor vehicle, and provided your injury is ‘reasonably ascertainable’ within one year of the crash, you will typically be covered. This amount of time permits you to have second opinions, get physical therapy, and surgical opinions, because there are times when an injury isn’t as easily diagnosed as seeing a broken bone on an x-ray.

When it comes to dealing with an insurance company, it is best to get the diagnosis sooner rather than later, because insurance companies look to the timing of your medical treatment and how soon after the crash you sought care. If there is a month or so delay between the crash and your treatment, the insurance company may investigate to see why you didn’t seek treatment sooner. The longer between medical care and the day of the crash, the more the insurance company will discount the doctor’s opinion that the crash caused the injury. It also makes medical sense to see your doctor to discuss the crash and what happened to you.

Regardless of whether you go to your primary physician, No-Fault medical care does not require that you have a referral to see a specialist, and often you get appointments sooner if you let the medical provider know you have a No-Fault case. I’ve been told by providers that a person injured in a car crash has a traumatic injury that may be more responsive to quick intervention than patients with long-term, or chronic, injuries.

So, the answer is “the sooner the better” when it comes to getting medical care in No-Fault cases, and especially when it comes to submitting your No-Fault claim.