Posted on September 19th, 2016 No comments
The Kentucky Tort Journal recently published a post summarizing the Court of Appeals recent published opinion discussing whether an insurer can unilaterally deny payment of no fault benefits after conducting a medical records review. Called a paper review, it involves a medical professional chosen by the insurer who will review an insured’s medical records and determine whether treatment performed was reasonable and necessary. If not, the insurer would deny payment for services rendered from a certain date and for future payment of further treatment.
This has been considered an end around Kentucky’s independent medical examination (IME) statute that provides judicial oversight from such unilateral decisions by insurers and the paid consultants that they employ. The Court found that such tactics violated the language and the spirit of the MVRA and its IME statute. This statute requires a finding of “good cause” on the part of the insurer in seeking the examination before an IME is ordered. The IME may or may not be found by the court to be warranted.
Consider the court review of an IME and subsequent finding of good cause with the unilateral attempts by insurers to deny benefits after a medical review by a professional of their choosing. The Court of Appeals found under the latter circumstances that the insurer was “judge, jury, and executioner.” It decline to grant such authority to the insurer. While a medical review may act as “good cause” to warrant an IME, it alone can’t form the basis of a decision by the insurer to unilaterally deny the payment of benefits. You can read the entire post, here.
If you have been denied the payment of basic reparation benefits, also known as no fault benefits, or personal injury protection benefits (PIP), you may have been denied those wrongly. In which case, you may be entitled to the payment of those benefits, plus interest and a reasonable attorneys’ fee. If you think you have wrongfully been denied benefits to which you are entitled as the result of a car accident, please contact our office.
Posted on April 14th, 2009 6 comments
Kentucky is a “no fault” state. Many people injured in accidents have been mistakenly told that if “no fault” is determined, then they don’t have an injury claim. This is not the case. In Kentucky fault is based on percentages. Each party is entitled to recover their damages for the other person’s fault up to 100%. For instance, if I am 35% at fault for causing an accident, I am still entitled to recover 65% of my total damages.
So what is meant by “no fault”? In Kentucky, injured person’s give up the right to sue the other person for their first $10,000.00 in economic damages, in exchange for receiving $10,000.00 in insurance benefits (PIP benefits). The term “no fault” means “no fault” is considered in the award of these benefits. Even if a person is 100% responsible for a car accident, they are still entitled to certain benefits if they were injured in a car accident.
The belief is that if an injured person’s medical expenses and lost wages (up to $10,000) are paid, they won’t be forced to file a lawsuit to recover those damages from the other person. This is supposed to lead to less fights over “fault” and actually result in the prompt payment of these damages.
Unfortunately, Kentucky’s “no fault” procedure is a statutory scheme that can be quite complicated. Avoid basing decisions regarding your potential claim on the statements of police officers, medical personnel, insurance adjusters, relatives or friends. You may need the services of a licensed attorney if there is an issue regarding fault for your accident or if your PIP benefits or bodily injury claim has been reduced or denied due to “fault”.