Quick Answer When a car accident insurance claim is denied, it's usually due to documentation gaps, missed deadlines, or disputed medical necessity. An attorney and a properly documented medical record are your strongest tools for appeal. MAIC produces court-ready documentation that withstands insurance company challenges.

Why No-Fault Claims Get Denied

No-Fault claims in New York are most commonly denied through the Independent Medical Examination (IME) process. The carrier schedules an exam with their physician, who concludes your injuries are not causally related to the accident, not medically necessary, or have reached maximum medical improvement. The carrier uses this to cut off benefits.

Your Right to Appeal

A No-Fault denial is not final. New York law provides an appeal through the American Arbitration Association (AAA) No-Fault arbitration system. An arbitrator reviews both the IME report and your treating physician's records, and makes a binding determination. The quality of your treating records is the most important factor.

What Makes an Appeal Succeed

IME reports are most effectively countered by contemporaneous treating physician records that contain: objective range of motion measurements, MRI findings with specific level and severity documentation, NCV/EMG correlation where nerve injury is present, and functional impact data showing how the injuries limit daily activity.

MAIC's treating physicians produce records specifically structured to address the common IME arguments — including the pre-existing condition defense and the causation gap argument. If your benefits have been cut off, contact MAIC immediately at (888) 991-5290 — there are strict time limits for arbitration demands.