Karen Wheadon, a paralegal who works with Ziff Law Managing Partner Jim Reed, has written the following blog post about no-fault insurance coverage.
Many of our clients are victims of car crashes, and therefore, subject to the rules and regulations of no-fault insurance. Unfortunately, many of our clients struggle financially because they have inadequate no-fault coverage.
Briefly, state-required minimum no-fault insurance consists of $50,000 in coverage for the following:
- All necessary doctor and hospital bills and other health service expenses, payable in accordance with fee schedules established or adopted by the New York State Insurance Department.
- Eighty percent of lost earnings up to a maximum monthly payment of $2,000 for up to three years following the date of the crash.
- Up to $25 a day for a period of one year from the date of the accident for other reasonable and necessary expenses the injured person may have incurred because of an injury resulting from the accident, such as the cost of hiring a housekeeper or necessary transportation expenses to and from a health-service provider.
- A$2,000 death benefit, payable to the estate of a covered person, in addition to the $50,000 coverage for economic loss described above.
When shopping for car insurance, many people don’t think to invest in anything other than that basic coverage. However, additional coverage can be purchased … and can make a huge difference to someone’s life and financial stability. When we consider the growing costs of health care, $50,000 does not last long.
Here are some examples of crash victims and their no-fault insurance coverage,
Mike, like many of our clients, receives Medicare benefits. He had a serious car crash and exhausted his basic no-fault coverage. His medical bills were then submitted to Medicare for coverage and he was personally responsible for co-pays. On top of that, under federal law, Medicare (and Medicaid) are allowed to assert a lien against any third-party recovery.
What that means for Mike is that the personal injury claim/lawsuit we filed against the person responsible for causing the crash and Mike’s injuries now has a lien against it. At the time of the settlement, Mike has to pay Medicare back from his settlement. Had Mike had additional no-fault coverage, he could have avoided his bills going to Medicare and kept more of his settlement for himself.
Michelle, injured in a car crash in 2016, had basic no-fault coverage that was paying her medical bills and was also reimbursing her for lost wages because she is unable to work. Like so many of our clients, Michelle relied on her monthly wage loss checks to pay for her basic necessities (mortgage, groceries, etc.).
Michele’s no-fault benefits were exhausted in May, leaving her with NO income at all. She has an application pending with Social Security Disability, but applicants often wait a year to hear if they are accepted or denied. If denied, the appeal process is even longer.
On top of that, Michelle’s private health insurance is through the Affordable Care Act. She has catastrophic coverage only with a $6,000 deductible. The neck surgery that was being scheduled is now on hold because she cannot afford to pay a $6,000 deductible without any income.
Obviously, Michelle would have benefited greatly from additional no-fault coverage. Her story is a great argument for universal health care because her health insurance plan is abysmal. She is a hard-working, taxpaying citizen who found herself with a disability and unable to work after a car crash. She should not have to put off medical treatment because she can’t afford her co-pay.
Opponents of universal health care argue that they don’t want the government making their medical decisions, but insurance companies already do that all the time. They arbitrarily decide a patient only needs 10 physical therapy sessions, or that they can’t have a drug prescribed by their doctor because it is too costly, or that surgery is not necessary because they have not exhausted conservative treatment options. Insurance companies base these decisions on money – their money that they would rather not pay out!
My stepson, Justin, was involved in a near-fatal car crash in 2015. He was taken from the scene of the crash by ambulance to Arnot Ogden Medical Center in Elmira, and then quickly transferred to Robert Packer Hospital in Sayre, Pa. From there, he was life-flighted to Geisinger Medical Center in Danville, Pa., where he was admitted for more than a month and underwent numerous surgeries to repair his fractured neck and re-attach a shoulder and arm.
There are a lot of miracles associated with Justin’s crash – too many to recount here. The fact that he is alive and well and now a father of two beautiful little children is sometimes more than I can believe. We are very, very blessed. But as you can imagine, the medical bills were astounding. The life-flight bill alone was $54,999, which was paid in full by his primary no-fault coverage.
Luckily, in addition to the basic no-fault coverage of $50,000, Justin had $10,000 of med-pay, $25,000 of OBEL (Optional Basic Economic Loss), and $150,000 of APIP (Additional Personal Injury Protection). He had such incredible coverage because he was the passenger of a vehicle that had more than basic coverage and he was also covered under his own policy which had even better coverage. This is far from the norm.
But even all of that coverage was very quickly exhausted, leaving a balance due to Geisinger Medical Center in excess of $1 million. This was turned over to his health insurance.
Justin was 23 years old at the time of his crash, but thankfully he was still covered by his father’s health insurance plan as a result of the Affordable Care Act, which extended medical coverage for children up to age 26. Donations from friends and family through a gofundme campaign covered the deductible, so Justin did not have to file bankruptcy because of insurmountable medical debt, as so many Americans do.
Justin’s example shows that even incredible no-fault coverage cannot adequately cover you from a catastrophic injury. But catastrophic injuries are, thankfully, rare.
The vast majority of our clients are like Michelle and Mike. They have broken bones that may or may not need surgery. Most of our clients seek medical treatment locally and don’t have multiple ambulance and life-flight bills. However, even routine injuries that require fairly routine medical treatment will quickly exhaust a basic no-fault policy.
So make the wise choice and protect yourself by asking your insurance agent about increasing your no-fault coverage. Had Michele or Mike had Justin’s maximum no-fault coverage, they would not be facing hard financial and medical decisions. We hope you won’t have to, either.
Therefore, we recommend adding Additional Personal Injury Protection (APIP) of at least $75,000 and Supplementary Underinsured (SUM) Coverage of at least $250,000. The good news is that adding this additional protection does not cost much more but will give you much better protection.
If you have questions, or would like us to review your insurance policy for free, please email me at [email protected] or Jim Reed at [email protected].
Thank you for reading,
Ziff Law Firm