Legal Question in Personal Injury in New York

Reconsideration after no fault denial

Once a no-fault insurer sends you for an IME and their doctors help deny a person's claim,can that person send a formal letter to the insurance company to ask for a reconsideration?

If that fails to work and a person wants to hire a lawyer to defend their stance,must the insurance company pay for the attorney,or can that be included in the complaint?

I have an attorney who doesn't seem too keen on forcing the insurance companies hand.

I was involved in an accident(7/27/2005) with a commercial vehicle,in which I sustained injuries.From the beginning,I was complaining of pain all on my left side(cervical thoracic and lumbar regions.Just recently(last month)I went for a discogram that proved the pain on my left side.To make a long story short,the (L5-S1)disc had to be removed(decompression and fusion with instrumentation-surgery completed 8/1/2006).The recent MRI films show that the symptoms had gotten worse.

What are my options at this point and who would be the responsible party to pay for the legal fees?


Asked on 8/19/06, 9:19 am

3 Answers from Attorneys

Mark S. Moroknek Kelly & Curtis, PLLC.

Re: Reconsideration after no fault denial

In NY, decisions by a No fault insurer, following an IME, to deny further benefits are generally handled through Arbitration of the Dispute. You should have been provided with information about appealing a denial by the insurer.

The Insurance Department has an agreement with the American Arbitration Association, who also have info about this on their web site.

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Answered on 8/20/06, 1:36 am

Re: Reconsideration after no fault denial

You have several options. You can file for arbitration against the insurance company. If you win, your lawyer gets attorney fees paid by the insurance company. You can also start a lawsuit against the insurance company. There are risks to doing either because if you get a decision against you, it could hurt your case against the car that hit you. If you have private insurance, you can use that in the meantime and go after the insurance carrier when the case is done. These are issues you need to discuss with your lawyer. I advise that the same lawyer who handles your accident case handle the insurance issue as well. If you are unhappy with your lawyer, please feel free to contact me about your case. We have 10 offices downstate and 1 in New Jersey.

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Answered on 8/19/06, 9:38 am
David Simon Hogan & Rossi

Re: Reconsideration after no fault denial

Adding to what my colleagues have already advised you, look the back of the denial form - it gives you your options.

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Answered on 8/20/06, 2:53 pm


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