The term “No-Fault” generally refers to the insurance policy that covers MVA’s (Motor Vehicle Accidents), which is the technical term for car accidents. It is called No-Fault because it does not matter whose fault the accident was. Whichever company insured the vehicle (car) you were in (either as a driver or passenger) is supposed to cover any medical expenses you may have as a result of the accident (up to a certain limit – normally $50,000).
If you are a pedestrian that was struck by a vehicle, the insurance of that vehicle covers the medical bills. No-Fault cases are generally much simpler than Workers’ Comp cases. There are only a few forms you need to know. Furthermore, there is no No-Fault equivalent to the Workers’ Compensation Board and, as such, there are no hearings that you need to attend. There are, however, some similarities between No-Fault and Workers’ Comp.
Namely, they are paid at the same rates (“fee schedule”) and both may involve the patient undergoing Independent Medical Examination. This is a medical examination performed by a doctor that has a relationship with the insurance carrier. They can either be an employee of the carrier or they may be under contract with them and paid per case. This is something akin to a second opinion. It is done to ensure that the treatment the patient’s doctor is providing or requesting is necessary. A majority of Workers’ Comp patients will be asked by the insurance carrier to undergo one or more IMEs.
You must attend the IMEs or else your benefits may be cut off. The patient will normally be informed in writing that they must attend an IME. An IME doctor would state whether they believe a patient requires additional treatment or not. If your doctor states you need further treatment but the IME doctor states that you do not, the issue then needs to be resolved by the WCB (either at hearings or in a deposition)IMEs.