Does A No-Fault Claim Guarantee A Settlement?

Contact the personal injury attorneys at Maya Murphy, P.C. today. We can help you get the just compensation you deserve for your injuries or those of a loved one. For a free initial consultation, call 203-221-3100 or email JMaya@Mayalaw.com.

If you live in one of the dozen or so no-fault states, if you get into a car accident, you should know that while no-fault car insurance rules are meant to facilitate the injury claim process, that does not always guarantee that you will get a settlement. Read on to learn more.

What is No-Fault Car Insurance?

In order to understand exactly why you wouldn’t automatically get a settlement in a no fault state, you need to understand what no fault insurance is. There are two important parts to no fault insurance. The first part is that, if you get into a car accident, your own automobile insurer will pay some or all of your medical bills and lost earnings, regardless of who was at fault for the accident.

Even if you caused the accident, your insurance company will still pay for your medical bills and/or lost earnings up to a certain limit. In most no fault states, there is a limit to what benefits your own automobile insurance company will pay you. This limit differs from state to state.

The second half of the no fault law is that you are generally not allowed to make a liability claim for personal injury damages (including pain and suffering) against the negligent driver unless your medical bills reach a certain monetary threshold or you have suffered qualifying “serious injury”.

As an example, a state no fault law might prohibit claims for personal injury damages against the driver at fault unless the injured person’s medical bills exceed $5,000.

Can I Settle a No-Fault Claim?

When thinking about a no-fault settlement, the first thing to remember that the only benefits that you are settling in a no-fault claim are medical bills and/or lost earnings. And because most states put a limit on the amount of medical bills and lost earnings that an injured person can recover under the no fault laws, a no-fault settlement would not be very large. And in some cases, the insurer may refuse to pay for certain claimed losses.

Let’s take a couple of examples. Let’s say that you got into a car accident and incurred $3,000 of medical bills and $2,000 of lost earnings, and that both of these amounts are within your state’s no-fault limits. In most cases, the no-fault insurer will simply pay the bills and pay the lost earnings, as long as you submit the proper proof of earnings. Thus, because the no-fault insurer paid all of the no-fault damages to which you are entitled, there is nothing further to settle.

Now let’s look at an example on when you might get a “settlement” that is less than what you are asking for. Typically, you would settle a no-fault case when there is a serious dispute between you and the insurer as to reasonableness and/or relatedness of your medical bills or as to the amount of your lost earning claim. Let’s say that you have $12,000 of medical bills, which is within your state’s no-fault limits, but that you incurred half of those bills after your doctor released you to return to work. Let’s also say that most doctors only charge $8,000 for all of that treatment.

In this case, the insurer might claim that the medical treatment after you returned to work was unnecessary and might also claim that the bills were too expensive in the first place. No-fault insurers are still allowed to contest things like the medical necessity of treatment and the amount of the bills. Insurers are only required to pay medical bills that are fair and reasonable. If a bill is too high, the insurer won’t pay it. But, after a bit of negotiation, you (or your lawyer), the insurer, and the doctor might come to an agreement and settle the no-fault claim. Perhaps you might all agree that the doctor will accept another $1,500 and call it even. That would be an example of a no-fault settlement.

A key thing to remember about no-fault settlements is that, especially if the settlement is about unpaid medical bills, the settlement amount won’t go to you; it will go to the health care provider.

At Maya Murphy, P.C., our personal injury attorneys are dedicated to achieving the best results for individuals and their family members and loved ones whose daily lives have been disrupted by injury, whether caused by a motor vehicle or pedestrian accident, a slip and fall, medical malpractice, a defective product, or otherwise. Our attorneys are not afraid to aggressively pursue and litigate cases and have extensive experience litigating personal injury matters in both state and federal courts, and always with regard to the unique circumstances of our client and the injury he or she has sustained.
Source: Nolo