October 7, 2016

Question

I was a pedestrian and hit by a car in my driveway, I was hospitalized for a few days with leg, ankle and jaw breaks. The accident was April 2012. I sued the insurance, and under a lawyers advise, settled for a settlement along with no fault coverage on the area. He made me believe it would be as long as I needed in order to get better. However it seems as once a year i have a surgery in those injury areas. I am 30 and doctors have now discovered i have post-traumatic arthritis and that surgery is needed within the next 10 years. which was due to the accident.
Any way last year i had a surgery in which plates and screws were removed, the surgery was around $10,000. Before the surgery i made it clear i could not pay and i needed to make sure it would go through no fault, i was told it would. Now i am getting a bill. when i called the hospital the billing department, they said no fault denied it due to untimely filling? I am unsure if that was their fault on not filling. or if they denied it for another reason. im not sure who is responsible for this bill.

how long will my coverage last? I do receive yearly statements

Answer

You need to ask the lawyer that represented you. In the forms you sign when you go for treatment, your no-fault benefits are usually "assigned" to your medical providers, so that they need to timely submit their bills for payment. If they get a denial from the insurance co., they usually need to pursue it through arbitration. It won't stop them from billing you as well, so take this up with the lawyer who handled your case.


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