Legal Question in Personal Injury in New York

Medicare and No Fault Insurance

I was involved in a MVA in 2005 and my insurance company(have 50k+50k PIP) sent me to their doctors;needless to say their IME doctors claimed I was alright.I am still receiving treatment and two more surgeries are expected(three surgeries already) this year.

As the Medicare conditional payment bills have totaled over 100k, can I now send the insurance company a letter to reconsider their stance, or will Medicare do this on my behalf?

I failed to mention that the MVA was not my fault and my insurance company failed to agressively represent me during subrogation,so they raised my premium and attached the accident to my insurance premium,which I am now paying for(even though initially they stated that my accident was not my fault;zero liability.


Asked on 8/02/08, 5:07 pm

1 Answer from Attorneys

Re: Medicare and No Fault Insurance

The PIP benefits of your auto insurance policy max out at 50K. It is unclear how much of that amount your carrier paid to medical providers before cutting you off. If they paid the full 50K (as several surgeries could amount to) your benefits were exhausted. If they cut you off before paying out the full 50K the letter you received from the carrier gave you (and the attorneys presumably handling your personal injury case against the other car) three choices: 1. complain to the NYS Department of Insurance; 2. Go to arbitration with paid bills for medical treatment; or 3. Add the medical expenses to your personal injury case. If Medicare picked up the bill-paying after no-fault cut you off they will likely not communicate with your auto insurance carrier. They may, however, impose a lien for payments made and look to claim money from you out of any settlement/moeny judgment you receive in the personal injury case when it's over. Hope this answers your question. Best, M. E. Zuller (NYC)

Read more
Answered on 8/03/08, 9:56 am


Related Questions & Answers

More Personal Injury Law and Tort Law questions and answers in New York