If the injured individual assigns no-fault benefits to his or her medical provider and the insurance company denies the provider’s claim, can the medical provider pursue the patient directly for payment of the bill?
Generally, a physician who accepts a no-fault assignment of benefits from a no-fault patient may not pursue the patient directly for payment. The form for no-fault assignment of benefits is considered a legal contract. Under that contract, the physician assumes the legal rights to no-fault benefits held by the injured party.
The insurance company can successfully deny the claim for a few reasons, including the lack of insurance coverage because of fraud by the patient, or a policy violation, such as the patient’s failure to appear at independent medical evaluations (IMEs). In those instances, payment could be sought from the patient. The physician can also pursue payments from the patient when payments from the no-fault policy are exhausted.