As a no-fault attorney and a baseball fan I was very intrigued by a recent ESPN article. Barry Zito, a pitcher for the San Francisco Giants, was involved in a car accident in which he was not at fault. After the accident Mr. Zito stated that he felt pretty good but had some soreness. What really caught my attention was that he was scheduled to undergo an MRI less than 24 hours after the accident “to be checked out if he had injuries or not.”
It is unsurprising that Mr. Zito’s treating doctors referred him for an MRI immediately following his car accident. MRI’s provide doctors with an invaluable tool when treating victims who have suffered trauma to the spine caused by a car accident. MRI’s identify neurological and other specific injuries that X-Rays and other testing cannot. It is an invaluable diagnostic tool that assists doctors in formulating the best treatment plan for a patient.
If you are one of the millions of New York State motorist required to pay car insurance premiums for medical coverage, you might be surprised to learn that your no-fault insurer does not believe you are entitled to the same basic medical care as Barry Zito. Should you find yourself in a similar situation and your doctor requests an immediate MRI to diagnosis the injuries, your no-fault insurer will almost certainly deny the MRI as not “medically necessary.”
Our office represents many radiologists who provide diagnostic testing for victims injured in car accidents. My experience representing the doctors has made me well aware that as a matter of course, a no-fault insurer will deny paying any claim for an MRI that takes place within the first month of conservative care and treatment.
No-Fault insurers have been very successful in convincing arbitrators and judges that established medical evidence dictates that an MRI should not be performed on an injured car accident victim within the first six weeks of the accident. The insurance company hired doctors will deny the claim using justifications such as “the early use of MRI’s are discouraged,” “there is no urgency to order the MRI of the cervical spine in the acute phase of treatment,” or “MRI testing should only be ordered if six weeks of conservative care has failed.”
Unfortunately, in the no-fault insurance scheme, it has become established that absent extraordinary circumstances, an injured car accident victim is not permitted an MRI unless he or she first undergoes six weeks of conservative treatment. It is irrelevant what the treating doctor’s medical opinion is or the level of pain the patient is experiencing. This begs the question of how can a proper treatment protocol be established when the treating physician does not know the severity and extent of the spinal injuries?
It is bad enough that Barry Zito earned 19 million dollars last year for three wins and an ERA of 5.87. He does not deserve better basic medical treatment than the rest of us for injuries arising out of a auto accident.
