NY Insurance Law and the Gap in Treatment

What is the “Gap in Treatment” rule under the NY Insurance Law?

Serious Injury Law

When you are involved in a motor vehicle accident in the State of New York, you are entitled to no-fault benefits that will cover your medical expenses.  Many times your no-fault carrier will cut-off your benefits before you have been discharged from your doctor’s care.  Should this occur, you should never stop your treatment without first talking to your doctor and your lawyer.

Mind the Gap

No, not the gap between the subway car and the platform.  Rather, an unexplained gap in your medical treatment.

In New York, in order to recover monetary compensation for personal injuries sustained in a motor vehicle accident, you must have sustained a “serious injury” as defined by § 5102(d) of the Insurance Law.

“Serious injury” is defined as “a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system; or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material  acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.”

Mind Your Doctor’s Advice

Do not concern yourself with what category of injury you fall into.  Your doctor will give her opinion.  You must, however, be sure to follow her advice as it concerns your treatment.

Any unexplained gap in your treatment can result in the Court dismissing your case for failing to meet the serious injury requirement under the law.

Many times your no-fault insurance will cut-off your benefits before your doctor discharges you from her care.  This is not an excuse in the eyes of the law to stop treatment, and the Court may dismiss your case if you failed to continue the advised treatment of your doctor.

What to Do?

There are many options that are available to you when your no-fault benefits are cut-off before your doctor has discharged you from her care.  You should immediately contact your lawyer to discuss your options as soon as there is any  question of your no-fault coverage.  NEVER stop your treatment without the advice of you doctor.  Not only may this be dangerous for your health, but you may also be jeopardizing your claim.

Any unexplained gap in treatment under the NY Insurance Law can be detrimental to your case.