Common Reasons for Claim Denial
- Late filing: PIP application not filed within 30 days
- Treatment deemed unnecessary: Insurer's IME doctor concludes treatment wasn't medically necessary
- Policy issues: Coverage lapse, exclusions, or coverage disputes
- Pre-existing condition arguments: Insurer claims injuries predate the accident
- Missed deadlines: Bills not submitted within the required 45-day window
- Fraud investigations: Claim flagged and suspended pending review
Appealing a No-Fault Denial
No-fault disputes in New York are handled through the No-Fault Arbitration process under the Insurance Department. Your attorney or medical provider can file for arbitration challenging the denial. MAIC physicians can provide supporting documentation and IME rebuttal reports to support your appeal.
Appealing a Personal Injury Claim Denial
If the at-fault driver's insurer denies your liability claim, your attorney can file a lawsuit within the statute of limitations. Strong medical documentation — causation narratives, objective imaging, functional assessments — is the foundation of any contested case.
MAIC provides supplemental reports and IME rebuttals to support denied claims. Talk to your attorney and call us at 866-404-MAIC.