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No-Fault Physical Examinations

doctor examination

If you are injured in an automobile accident in New York State, your medical bills and lost wages, if any, are paid by the automobile liability carrier that insures the vehicle in which you were a driver or a passenger.

Medical bills must be paid by the responsible carrier even if the injured party was at fault or contributed to the happening of the accident. No Fault legislation was originally enacted in New York State in 1974.

However, under No-Fault regulations, the auto insurance carrier can compel the injured person to undergo a physical examination by a physician (or other health care provider) it chooses.

Moreover, courts in New York have determined that if treatment continues over time, the auto insurance carrier can require the injured person to undergo multiple physical examinations as long as there is a reasonable basis for conducting them. The carrier has to reimburse the injured person for mileage expenses and lost wages incurred in attending the examination(s).

Upon receipt of a  Notice for a Physical Examination, pay attention to the date and time of the examination and plan to attend. If you fail to appear for two examinations, your No-Fault benefits will be terminated. This can be a substantial penalty, since you may be entitled to $50,000 (or more) in benefits to cover medical expenses indefinitely, as well as lost wages for three years following the accident.

When you receive such a Notice, contact your attorney and let her/him know the date and time of the No-Fault examination. Many  firms will assign a lawyer or paralegal to accompany the injured client to the examination. If you have no attorney, you will have to try to protect your own interests at the time of the examination. In order to do so, you need to know a few things about the nature and extent of the examination that you will undergo.

The Examining Doctor is Not Your Friend

No matter how personable he/she appears, the examiner does not have your best interests at heart. The doctor or chiropractor was hired by or at the request of the auto carrier which is paying your No-Fault benefits.

The examiner will send a written report of your examination to the insurance company. The insurance company is hoping that the examining doctor will decide after the examination that your injuries have resolved, that your injuries are unrelated to the auto accident, or that additional treatment will not improve your condition.

If the examiner writes in the report that in his/her opinion any of those factors are true, the insurance company will then advise you that it will not pay for any more medical expenses or lost wages that you sustained in the auto accident.

The History

Upon arrival at the office on the day of your examination, you will be asked to fill out a multi-paged questionnaire by the secretary, and provide your driver's license for photocopying.

The doctor is entitled to know that you were in fact injured in an auto accident, the mechanism of the injury, and, if applicable, whether you were wearing a seat belt when the accident occurred. The doctor and his staff also need to learn if you injured the same body part(s) involved in the accident both before and/or after the accident.

Feel free to refuse to answer inquiries on the questionnaire or asked verbally by the doctor that pertain to health information that is unrelated to the injuries that you suffered in the accident. You do not have to discuss your hysterectomy when you broke your  left elbow in the accident.

It is important to also understand that the doctor or chiropractor has access to all of your medical records pertaining to your accident treatment in the file provided by the insurance company before you walked into the office.

You may be questioned by the doctor in some detail about hospital or physician care that you underwent after the accident. If you don't remember some aspect of your medical history following the accident or the complaints that you made when you had an office visit, it's perfectly fine to tell the examiner that you can't recall. You want to be credible, so avoid guessing during the history portion of the process.

However, it's important to inform the examiner of all physical problems  and  injuries that you experienced, even if some of those ailments ceased before the examination. It is also advisable to give concrete examples of your pain in the history narrative. For example, rather than simply saying that you have shoulder pain, tell the examiner also that your shoulder hurts when you reach for the coffee cup in the cupboard.

You may also be asked if you brought medical records or X-Rays with you. Rest assured that failing to bring such materials with you has no bearing on your examination.

The Examination

After the history is completed, the physical examination occurs next. Depending on the nature of the injuries, you may be asked to change into a gown. The examiner will ask you to sit or lie down on a table while he/she performs the examination.

Motor vehicle accident injuries generally involve injuries to your bones, spine, or soft tissues which can be quite painful even if no fractures were sustained. The examiner may ask you to stand, squat, kneel, walk, and/or walk on your toes. Often, you are told to reach, bend, stretch your arms/legs, and move your head up/down and from side to side.

A critical point to keep in mind during the course of the examination is that you must tell the doctor when you are performing these activities if you feel  pain, even if it is minor.

This part of the examination, when you are moving your torso in response to the direction of the doctor, is known as active range of motion (AROM). In addition, the examiner may also do a " hands on" technique, where he/she moves parts of your body without any input from you. This is known as passive range of motion (PROM). Once again, while the doctor is manipulating your body during this procedure, it's essential to make it known anytime that you feel pain.

When the physician, chiropractor, or other health care provider advises that the examination is over, do not have any further conversation with him or her. Do not ask the examiner for recommendations about your future medical care or what therapy you should consider.

While it may seem that you have just undergone an office visit similar to the type you have experienced with your own doctors, you have not been treated by the No-Fault examiner, and he/she has no loyalty or allegiance to you. As soon as you learn that the exam is done, get dressed and leave the office.

The Report

You are entitled to receive a copy of the report that the No-Fault examining doctor prepares and forwards to the auto insurance carrier.

The best case scenario is that the examiner found that your injuries were accident related and continuing medical treatment and absence from work is justified under the circumstances.

On the other hand,  the carrier may send you a notification that some or all of your No-Fault benefits have been eliminated based on the opinions of the examiner that are set forth in the written report. For instance, you may be informed by the carrier that it will no longer pay for future physical therapy sessions. Unfortunately, you may be told that no care of any nature is required, you are fit to return to work, and no further medical payments or lost wage checks will be issued.

It is easy to see how the No-Fault examination and accompanying report can be utilized to your detriment as a person injured in a motor vehicle accident in New York State.  If you are caught in the predicament where you need further treatment and/or can not work after your No-Fault benefits have been terminated, consult an attorney to discuss your options.

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