The No Fault Insurer Sent Me to Their Doctor and Cut Off My Physical Therapy. What Can I Do in New York?

You can challenge a no fault cutoff that follows the insurer's medical exam. Your own treating doctor documents in writing why you still need care, and that record is used to fight the denial through New York's no fault arbitration or in court, where a 15 minute exam has to hold up against months of your treatment history. The first thing to do is keep going to physical therapy while that plays out, because stopping is what hurts you most.

This is the counterintuitive part, and it is the most time sensitive. A denial letter tells you the insurer will stop paying. It does not tell you to stop treating, and treating people usually should not.

The reason is your health first and your case second. If you're still in pain, you still need care, and a break in treatment becomes a problem later. When the insurer or a defense lawyer sees a gap between your sessions, they make an easy argument: if you were really hurt, you would have kept going. That gap can cost you far more than a few weeks of copays.

There are usually ways to keep the care going. Your treating provider may continue on a lien, meaning they wait to be paid out of a future settlement instead of billing you now. Some patients shift accident related visits onto their private health insurance. You can get a second opinion on your treatment if you want a fresh read on what you actually need. The point is to not let the insurer's letter be the reason your recovery stops.

What happened is worth naming plainly. The insurer scheduled what it calls an independent medical examination, or IME. Despite the name, that doctor is retained and paid by the insurance company, examined you briefly, and wrote that further treatment is not medically necessary. Under New York's no fault regulations, 11 NYCRR Part 65, that report is what lets the carrier stop paying going forward.

One paid opinion from a short exam is not the last word, and it does not overrule the doctor who has actually been treating you. Your physiatrist, orthopedist, or physical therapist knows your imaging, your progress, and your daily limits. Their written opinion carries real weight against a 15 minute exam. The cutoff is the start of an argument, and it is an argument you are allowed to have.

Three moves, in order.

First, get a written report from your treating doctor, a letter of medical necessity, spelling out your objective findings and why continued therapy is required. Specific clinical detail is what answers an IME report that glossed over your condition.

Second, challenge the denial itself. Disputes over no fault medical necessity in New York are decided through arbitration run by the American Arbitration Association, and they can also go to court. Your treatment records go up against the IME report in front of a neutral arbitrator. A termination notice doesn't mean the insurer is right. It means a dispute exists, and disputes get decided by someone other than the insurance company.

Third, act on the notice rather than sitting on it. No fault runs on tight deadlines, and the sooner your side is documented and the denial is contested, the stronger your position. This is exactly the kind of thing worth a free phone call to sort out before more time passes.

No fault, also called PIP, is meant to cover more than medical bills. It pays a portion of your lost earnings and certain other accident expenses, up to the basic policy amount of $50,000 per person, no matter who caused the crash. When an IME concludes you can return to work or no longer need care, the same report is often used to shut off the lost wage benefit along with the therapy payments.

That denial is challenged the same way. Your treating doctor's disability documentation, kept current, is what supports continued wage benefits, and the suspension can be disputed through the same no fault process. If wages have stopped and you are still unable to work, that belongs in the conversation with a lawyer, not written off.

These are two separate tracks, and it helps to see them that way. No fault is a first party system, your own insurer, for medical bills and lost wages. Your claim for pain and suffering runs on a second track, against the driver who caused the crash. That is your injury claim against the at fault driver, and it is usually where the real compensation for a serious injury lives.

The two tracks touch in one important place: the record. The IME report and any gap in your treatment can be handed to the defense in the injury case as evidence that you healed. That is why continuing care and keeping your documentation clean matters on both tracks at once. Well documented, consistent treatment protects the therapy you need now and what a New York injury case can actually recover later.

Karasik Law Group, P.C. has approximately 19 years of experience in personal injury law and represents injured drivers across all five boroughs and New Jersey. Alexander Karasik, Esq. conducts the free consultations personally, and clients reach their attorney directly by phone, text, email, or in person rather than through a case manager. The firm handles car accident and injury matters on contingency, advances the costs of the case, and clients pay nothing unless and until there is a recovery, so how the fee and the costs work is not a barrier to asking. The office works with clients in Spanish and Russian as well as English, and can meet you at home or in the hospital if travel is hard. These are trial attorneys who will take a case to trial where that is what a fair result requires, and some results the firm has posted are on the site. Past results do not guarantee future outcomes.

If your therapy or your benefits were cut off after an insurer's exam and you are still in pain, reach the office for a free review of the denial before you stop treating or let a deadline slip.

Generally yes. No fault rules treat the exam as a condition of your coverage, and an unexcused failure to attend can itself be a reason the insurer denies benefits. Go, be accurate, and keep it factual.

Describe your pain and limits honestly and completely, without exaggerating or downplaying. Note the time the doctor actually spent and what was and was not examined. Those details can matter if the report later minimizes your injury.

Not necessarily. A gap makes things harder, not hopeless. Get back under care, and have your doctor document the reason for any break. It is worth reviewing with an attorney rather than assuming the case is lost.

No fault runs on short timelines throughout, so the safe answer is to act quickly rather than pin your hopes on a single date. Prompt documentation and a prompt challenge protect your position.

No. The consultation is free, and injury cases are handled on contingency, which means the fee comes out of a recovery, not your pocket now.

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