Navigating the New York no-fault system requires a deep understanding of the relevant statutes and regulations. We are well-versed in the laws that govern your benefits, including:

• N.Y. Ins. Law § 5102: This statute defines “basic economic loss” and outlines the specific benefits covered by your no-fault insurance, including medical expenses, lost wages, and other necessary expenses.
• 11 NYCRR 65: Known as “Regulation 68,” this is the New York State Department of Financial Services’ comprehensive regulation that governs the processing of no-fault claims. It sets strict timelines for insurers to acknowledge, investigate, and either pay or deny claims.
• No-Fault Application Deadlines: Under New York law, you must file a no-fault application (Form NF-2) with the insurer of the vehicle you were in (or the striking vehicle if you were a pedestrian) within 30 days of the accident. Medical providers must submit bills within 45 days of treatment. We ensure all documentation is filed correctly and on time to protect your rights.

Our approach is designed to streamline the claims process and maximize your chances of a successful outcome. Our process includes:

1. Document Review and Filing: We will review all related documents, including your signed assignment of benefits, denied bills, denial letters, and all medical records. Our goal is to file the necessary paperwork within seven days of receiving all documentation.
2. Challenging the Insurance Carrier: The burden is on the insurance company to prove that your medical treatment was not medically necessary. We meticulously build your case and are prepared to challenge any initial denials based on IMEs, peer reviews, or biomechanical reports.
3. Rebuttal and Escalation: Even if the insurance company initially submits the proper evidence for a denial, we have an opportunity to rebut their submission with additional evidence. If a fair settlement cannot be reached, we are prepared to pursue arbitration or litigation to secure the benefits you are owed.

The outcome of a no-fault claim dispute can vary, but our goal is always to achieve a favorable result for our clients. We pursue several avenues to resolve disputes:

• Settlement: Many no-fault disputes are resolved through negotiation and settlement. We work to reach an agreement with the insurance carrier that provides full or partial payment of the outstanding benefits. Settlements are often a quick and efficient way to resolve claims without the need for a formal hearing.
• Arbitration: If a settlement cannot be reached, we will file for arbitration with the American Arbitration Association (AAA), as outlined in New York’s no-fault regulations. During this process, an independent arbitrator—typically an attorney with experience in insurance law—reviews the evidence from both sides and issues a binding decision. The award may include the full amount of the unpaid benefits, as well as interest and attorney’s fees.
• Litigation: For cases that require a more formal legal process, we are prepared to file a lawsuit in court. Litigation is often the best course of action for complex claims or when the insurance company refuses to engage in good-faith negotiations or arbitration. In a successful litigation case, a judge will issue a judgment that compels the insurance company to pay the benefits you are owed.