Quick Answer If your No-Fault insurance claim is denied, you have the right to appeal. Common denial reasons include late filing, insufficient documentation, and IME disputes. MAIC's PI coordination team handles denial appeals and ensures documentation meets all No-Fault requirements.

Why No-Fault Claims Get Denied

No-Fault claims in New York are most commonly denied through the IME (Independent Medical Examination) process. The insurance carrier schedules an IME with a physician of their choosing, that physician produces a report concluding that your injuries are not causally related to the accident, not medically necessary, or have reached maximum medical improvement — and the carrier uses that report to cut off your benefits.

IME denials are not final. New York law provides a robust appeal process through the No-Fault arbitration system, and the quality of your treating physician's documentation is the most important factor in the outcome of that appeal.

The Appeals Process: No-Fault Arbitration

No-Fault benefit disputes in New York are resolved through the American Arbitration Association (AAA) No-Fault arbitration process. Your attorney submits a demand for arbitration, and an arbitrator reviews the clinical records — both from the IME physician and from your treating providers — and makes a binding determination about whether benefits should be restored.

The arbitrator compares the IME report against your treating physician's contemporaneous clinical records. A well-documented treating physician record — with objective examination findings, imaging correlation, and functional impact data — routinely prevails over an IME report based on a single examination. A poorly documented record, by contrast, leaves the arbitrator with little objective basis to restore benefits.

What MAIC Does to Support No-Fault Appeals

MAIC's treating physicians are experienced in the No-Fault arbitration process and can provide documentation support specifically addressing the IME physician's findings. This includes supplemental narrative reports addressing the IME's causation conclusions, sworn affidavits from treating specialists, and, where necessary, deposition testimony.

If your No-Fault benefits have been cut off after an IME — or if you have received a denial notice from your carrier — contact MAIC immediately at (888) 991-5290 to discuss your documentation options. Do not delay: there are strict time limits for No-Fault arbitration demands.